Family coaching and counseling - Dean Amory

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Family coaching and counseling - Dean Amory

  1. 1. ANAN INTRODUCTIONINTRODUCTION TOTO FAMILYFAMILY THERAPYTHERAPY Tags: Family Therapy - Practical Guide – Manual – Theory – Summary - Course – counselling – counsellor CompiledCompiled byby DeanDean AmoryAmory
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  3. 3. Title: An Introduction to Family Therapy Compiled by: Dean Amory Dean_Amory@hotmail.com Publisher: Edgard Adriaens, Belgium eddyadriaens@yahoo.com ISBN: PUBLIC DOMAIN PUBLICATION © Copyright 2013 Edgard Adriaens, Belgium, - All Rights Reserved. This book has been compiled based on information that is freely accessible in the public domain on the internet. Whenever you cite such information or reproduce it in any form, please credit the source or check with author or editor. If you are aware of a copyright ownership that I have not identified or credited, please contact me at: Dean_Amory@hotmail.com 3
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  5. 5. Cover Illustration: Zirta - Ilustrador, Diseñador, Historietista Beatriz Torres, 1981, Tampico, México. He dibujado historias toda mi vida. Estudié la carrera de Diseño Gráfico, pero mi verdadera pasión son los cómics. En 2001, mi amiga Shiaya y yo creamos HED: Hilando el Destino. En 2006 propuse Oseano como tira cómica al diario La Razón de Tampico, donde lo publiqué diariamente hasta 2011. Actualmente me desempeño como ilustradora freelance, y estoy trabajando en mi primera novela gráfica. Contacto: beatriz@zirta.net Zirta - Illustrator, designer, cartoonist I've drawn stories all my life. I studied Graphic Design, but my real passion is comics. In 2001, my friend Shiaya and I created HED: Spinning Destiny. In 2006 I proposed the comic strip Oseano to the newspaper “La Razón de Tampico”, and published daily until 2011. Currently I am working as a freelance illustrator and I am working on my first graphic novel. 5
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  7. 7. Preface All information in this manual was collected for personal use from freely accessible sites on the internet, a lot of it was found in the free encyclopaedia Wikipedia. The same applies to all pictures used, which I downloaded from public domain sites, with exception for the cover picture “la familia Dupont”, which was kindly made available to this purpose by its creator, Zirta (Beatriz Torres, Mexico). Since I feel many people will benefit and appreciate being allowed to get easy access to this kind of information ordered in short, easily accessible chapters, I decided to make this compilation work available for free to everybody as a download file. A printed copy of the manual can be purchased at http://www.lulu.com (http://www.lulu.com/shop/various-authors/practical-manual-of-family-therapy/paperback/product- 15478201.html) Should any of the authors of the borrowed texts feel that the present manual is not compatible with the way in which they planned to make their work available to the public, then I hereby invite them to contact me at Dean_Amory@hotmail.com and let me know which part of the manual should be adapted or replaced by information from other sources. 7
  8. 8. Family Therapy – Contents Cover Illustration:...................................................................................................................................5 Zirta - Ilustrador, Diseñador, Historietista ........................................................................................5 Preface......................................................................................................................................................7 Family Therapy – Contents....................................................................................................................8 Family Therapy – Background Information ......................................................................................23 History of Marital Therapy .................................................................................................................24 Phase I - 1930 to 1963 - Atheoretical...........................................................................................24 Phase II - 1931 to 1966 - Psychoanalytic Experimentation ..........................................................24 Phase III - 1963 to 1985 - Family Therapy Incorporates.............................................................24 Phase IV - 1986 to now - Refining and Integrating .....................................................................24 History and theoretical frameworks....................................................................................................25 Techniques ..........................................................................................................................................27 Publications.........................................................................................................................................28 Licensing and degrees.........................................................................................................................28 Values and ethics in family therapy....................................................................................................28 Founders and key influences...............................................................................................................29 Principal Leaders in the Field: ............................................................................................................29 Salvador Minuchin..........................................................................................................................30 Jay Haley.........................................................................................................................................30 Murray Bowen ................................................................................................................................31 Nathan Ackerman............................................................................................................................31 Virginia Satir...................................................................................................................................32 Ivan Boszmormenyi-Nagy ..............................................................................................................32 John Elderkin Bell...........................................................................................................................33 Philip Guerin ...................................................................................................................................33 Don Jackson ....................................................................................................................................33 Carl Whitaker..................................................................................................................................34 Betty Carter .....................................................................................................................................34 Michael White.................................................................................................................................35 Models and Schools ............................................................................................................................36 Some contemporary family therapies: ............................................................................................36 Structural Family Therapy (Minuchin, 1974, Colapinto, 1991) .....................................................36 Conjoint Family Therapy (Satir, 1967)...........................................................................................36 Contextual Therapy (Boszormenyi-Nagy, 1991)............................................................................36 Strategic Therapy (Madanes, 1981) ................................................................................................36 Brief Therapy ..................................................................................................................................37 Milan Systemic Therapy (Boscolo et al, 1987)...............................................................................37 Narrative Therapy (Freedman, Combs, 1996) ................................................................................37 Academic resources ............................................................................................................................37 Professional Organizations..................................................................................................................37 Useful Internet links............................................................................................................................38 Wikipedia links ...............................................................................................................................38 8
  9. 9. External links ..................................................................................................................................38 Brief Strategic Family Therapy ...........................................................................................................39 Description ..........................................................................................................................................39 Program background ...........................................................................................................................39 Indicated..............................................................................................................................................39 Content focus ......................................................................................................................................39 Intervention by domain .......................................................................................................................40 Parents as a primary target population:...........................................................................................40 Individual: .......................................................................................................................................40 Family : ...........................................................................................................................................40 Peer :................................................................................................................................................40 Key program approaches.....................................................................................................................40 Parent-child interaction:..................................................................................................................40 Parent training:................................................................................................................................40 Skill development: ..........................................................................................................................40 Techniques used..............................................................................................................................40 Therapy ...............................................................................................................................................40 How it works...................................................................................................................................40 There are four important BSFT steps:.............................................................................................41 Barriers and problems .....................................................................................................................41 Brief Strategic Family Therapy for Adolescent Drug Abuse............................................................42 Foreword .............................................................................................................................................42 Chapter 1 - Brief Strategic Family Therapy: An Overview................................................................43 BSFT is based on three basic principles. ........................................................................................43 Why Brief Strategic Family Therapy? ............................................................................................44 What Are the Goals of Brief Strategic Family Therapy?................................................................44 What Are the Most Common Problems Facing the Family of a Drug-Abusing Adolescent?........44 The Family Profile of a Drug-Abusing Adolescent ........................................................................45 The Behavioral Profile of a Drug-Abusing Adolescent..................................................................45 Negativity in the Family..................................................................................................................45 What Is Not the Focus of Brief Strategic Family Therapy?............................................................46 This Manual ....................................................................................................................................46 Chapter 2 - Basic Concepts of Brief Strategic Family Therapy..........................................................47 Context ............................................................................................................................................47 Family as Context ...........................................................................................................................47 Peers as Context ..............................................................................................................................47 Neighborhood as Context................................................................................................................47 Culture as Context...........................................................................................................................48 Counseling as Context.....................................................................................................................48 Systems ...........................................................................................................................................48 A Whole Organism .........................................................................................................................48 Family Systemic Influences ............................................................................................................48 The Principle of Complementarity..................................................................................................49 Structure: Patterns of Family Interaction ........................................................................................49 9
  10. 10. Strategy: The Three Ps of Effective Strategy..................................................................................50 Content Versus Process: A Critical Distinction..............................................................................51 Chapter 3 - Diagnosing Family System Problems ..............................................................................52 Leadership.......................................................................................................................................52 Subsystem Organization..................................................................................................................52 Subsystem Membership ..................................................................................................................52 Triangulation...................................................................................................................................53 Communication Flow......................................................................................................................53 Resonance .......................................................................................................................................53 Enmeshment and Disengagement ...................................................................................................53 Resonance and Culture....................................................................................................................54 Enmeshment (high resonance) and Disengagement (low resonance).............................................54 Developmental Stages.....................................................................................................................54 Assessing Appropriate Developmental Functioning.......................................................................55 Common Problems in Assessing Appropriateness of Developmental Stage..................................55 Life Context ....................................................................................................................................56 Antisocial Peers...............................................................................................................................56 Parent Support Systems and Social Resources ...............................................................................56 Juvenile Justice System...................................................................................................................56 Identified Patient .............................................................................................................................56 Conflict Resolution .........................................................................................................................57 A Caveat..........................................................................................................................................58 Chapter 4 - Orchestrating Change.......................................................................................................59 Establishing a Therapeutic Relationship.........................................................................................59 Joining.............................................................................................................................................59 A Cautionary Note: Family Secrets ................................................................................................60 Tracking ..........................................................................................................................................61 Encouraging the Family to Interact.................................................................................................61 Tracking Content and Process.........................................................................................................61 Mimesis...........................................................................................................................................61 Building a Treatment Plan ..............................................................................................................62 Enactment: Identifying Maladaptive Interactions...........................................................................62 Family Crises as Enactments ..........................................................................................................62 A Cautionary Note: Adolescents Attending Therapy Sessions on Drugs.......................................63 From Diagnosis to Planning............................................................................................................63 Producing Change ...........................................................................................................................63 Seven Frequently Used Restructuring Techniques .........................................................................64 1. Working in the present................................................................................................................64 2. Reframing: Systemic Cognitive Restructuring ...........................................................................64 Affect: Creating Opportunities for New Ways of Behaving...........................................................65 3. Reversals .....................................................................................................................................66 4. Working With Boundaries and Alliances ...................................................................................66 Behavioral Contracting as a Strategy for Setting Limits for Both Parent and Adolescent.............67 Boundaries Between the Family and the Outside World................................................................67 5. Detriangulation............................................................................................................................68 Attempts by the Family to Triangulate the Counselor....................................................................68 6. Opening Up Closed Systems.......................................................................................................69 7. Tasks ...........................................................................................................................................69 Central Role ....................................................................................................................................69 General Rule....................................................................................................................................69 Hope for the Best; Be Prepared for the Worst ................................................................................69 10
  11. 11. Chapter 5 - Engaging the Family Into Treatment ...............................................................................70 The Problem....................................................................................................................................70 Dealing With Resistance to Engagement........................................................................................71 The Task of Coming to Treatment..................................................................................................72 Joining.............................................................................................................................................72 Establishing a Therapeutic Alliance................................................................................................73 Diagnosing the Interactions That Keep the Family From Coming Into Treatment ........................73 Restructuring the Resistance...........................................................................................................74 Types of Resistant Families ............................................................................................................74 Powerful Identified Patient .............................................................................................................74 Contact Person Protecting Structure ...............................................................................................75 Disengaged Parent...........................................................................................................................76 Families With Secrets .....................................................................................................................76 Chapter 6 - Clinical Research Supporting Brief Stategic Family Therapy.........................................77 Outpatient Brief Strategic Family Therapy Versus Outpatient Group Counseling ........................77 Conduct Disorder. ...........................................................................................................................78 Association With Antisocial Peers..................................................................................................78 One Person Brief Strategic Family Therapy ...................................................................................79 Brief Strategic Family Therapy Engagement..................................................................................79 The six levels of engagement effort................................................................................................80 Efficacy of methods of engagement...............................................................................................80 References.......................................................................................................................................81 Solution focused brief therapy .............................................................................................................86 Contents...............................................................................................................................................86 Basic Principles:..................................................................................................................................86 Questions.............................................................................................................................................87 The miracle question.......................................................................................................................87 Scaling Questions............................................................................................................................88 Exception Seeking Questions..........................................................................................................88 Coping questions.............................................................................................................................88 Problem-free talk.............................................................................................................................89 Resources ............................................................................................................................................89 History of Solution Focused Brief Therapy........................................................................................89 Solution-Focused counselling .............................................................................................................90 Solution-Focused consulting...............................................................................................................90 References...........................................................................................................................................90 Brief (psycho-) therapy.........................................................................................................................91 Founding proponents of Brief Therapy...............................................................................................91 An Overview of Brief Therapy ...........................................................................................................93 The brief therapy solution-focused approach can be summed up in three stages,..........................93 Strategic Family Therapy.....................................................................................................................94 Haley Model........................................................................................................................................95 Behavior Problems..............................................................................................................................95 Family Interaction ...............................................................................................................................95 Therapy ...............................................................................................................................................95 Who Does it Help?..............................................................................................................................97 11
  12. 12. Bowen’s Strategic Family Therapy .....................................................................................................98 Contents...............................................................................................................................................98 Introduction.........................................................................................................................................98 The family system...............................................................................................................................98 There are eight interlocking concepts in Dr. Bowen's theory:........................................................99 1) Differentiation of self:.............................................................................................................99 2) Triangles:.................................................................................................................................99 3) Nuclear family emotional system: ..........................................................................................99 4) Family projection process: ......................................................................................................99 5) Multigenerational transmission process:.................................................................................99 6) Emotional cut-off: ...................................................................................................................99 7) Sibling position: ......................................................................................................................99 8) Societal emotional process:.....................................................................................................99 1. Differentiation of Self ...............................................................................................100 2. Triangles....................................................................................................................103 3. The Nuclear Family Emotional Processes ................................................................105 4. The Family Projection Process..................................................................................108 5. The Multigenerational Transmission Process ...........................................................112 6. Sibling Position .........................................................................................................114 7. Emotional Cut-off .....................................................................................................116 8. Societal Emotional Processes....................................................................................118 Areas of assessment ..........................................................................................................................120 1) Spousal relationships.................................................................................................................120 2) De – Triangulation ....................................................................................................................121 3) Differentiation Of The Self and Emotional Cutoff...................................................................122 4) Understanding family emotional systems.................................................................................123 Normal Family Development............................................................................................................126 Family Disorders...............................................................................................................................126 Family Therapy with One Person .....................................................................................................126 Goals of Therapy...............................................................................................................................127 The practice of Bowen family therapy is governed by the following two goals: .........................127 Treatment entails...........................................................................................................................127 More specifically, the therapist.....................................................................................................127 Techniques ....................................................................................................................................128 Other concepts:..............................................................................................................................128 More about Triangles ........................................................................................................................129 1. Cross-generational coalitions....................................................................................................129 2. The authors reviewed three family triangles:............................................................................129 3. The Emotionally Disturbed Child as the Family Scapegoat. ....................................................130 4. Marks, S. (1989). Towards a systems theory of marital quality. ..............................................131 seven different manifestations of the dual triangle construct........................................................131 Criticisms on the triangle theory...................................................................................................132 Salvador Minuchin’s Structural Family Therapy ...........................................................................133 Contents.............................................................................................................................................133 Family Rules .....................................................................................................................................133 12
  13. 13. The family – homeostasis & change .............................................................................................135 The presenting problem.................................................................................................................136 The Process of Therapeutic Change..................................................................................................137 Therapeutic Goals and Techniques ...................................................................................................138 See also..............................................................................................................................................138 References.........................................................................................................................................138 Definitions.........................................................................................................................................139 Structure, subsystems and boundaries...........................................................................................139 Examples demonstrating boundaries and subsystems...................................................................139 Reaction to change:.......................................................................................................................140 As with boundaries, hierarchies can be either be too rigid or too weak .......................................140 Salvador Minuchin’s Style............................................................................................................140 Family member behaviour can be understood only in the family context....................................141 Counselors must differentiate between first-order and second-order changes. ............................141 Key concepts:................................................................................................................................141 Three reasons that make clients move: .........................................................................................142 Conditions for behaviour change ..................................................................................................142 Four sources of family stress: .......................................................................................................142 Sets:...............................................................................................................................................142 Goals: ............................................................................................................................................142 How therapy addresses boundaries ...............................................................................................143 Interventions:.................................................................................................................................144 Assessment of therapy...................................................................................................................144 Four steps identified by Minuchin and his colleagues..................................................................144 Therapy techniques : The seven steps of family therapy ..............................................................144 Step 1: joining and accommodating..............................................................................................144 Step 2: Enactment .........................................................................................................................145 Step 3: structural mapping ............................................................................................................145 Step 4: highlighting and modifying interactions...........................................................................145 Step 5: boundary making ..............................................................................................................145 Step 6: unbalancing.......................................................................................................................145 Step 7: challenging unproductive assumptions.............................................................................146 Conclusion.....................................................................................................................................146 Virginia Satir’s Humanistic Family Therapy...................................................................................147 Key concepts:....................................................................................................................................147  Turn roles into relationships, rules into guidelines. ..................................................................147 Interventions:.....................................................................................................................................147 Criteria for termination: ....................................................................................................................148 Behavioural & Conjoint Family Therapy.......................................................................................149 Matching intent and impact of communication. ...............................................................................149 The four components in a family situation that are subject to change are........................................149 The three keys to Satir’s system are..................................................................................................149 Communication and Response Patterns............................................................................................150 The counseling method of conjoint family therapy involves............................................................150 Games................................................................................................................................................150 The Counsellor’s Role.......................................................................................................................151 Key Concepts ....................................................................................................................................151 13
  14. 14. Milan Systemic Family Therapy or “Long Brief Therapy”..........................................................152 Key Concepts: ...................................................................................................................................152 Therapy: ............................................................................................................................................152 Interventions:.....................................................................................................................................152 Assessment....................................................................................................................................153 Family Development through a systemic lens ..............................................................................154 The process of change...................................................................................................................155 Roadblocks to family developmental change ...............................................................................157 Interventions that create a context for developmental change......................................................157 Conclusion.....................................................................................................................................158 Response-based Family Therapy.......................................................................................................159 Therapeutic Methods.........................................................................................................................159 References.........................................................................................................................................160 Related Reading ................................................................................................................................160 Contextual Family Therapy Approach .............................................................................................161 The core of Contextual Approach rests on two postulates................................................................161 Four-Dimensional Interventions .......................................................................................................162 Facts ..............................................................................................................................................162 Individual Psychology...................................................................................................................162 Transactions ..................................................................................................................................163 Critics ................................................................................................................................................163 Entitlement ........................................................................................................................................164 References and Bibliography ............................................................................................................165 Narrative Family Therapy .................................................................................................................166 Contents.............................................................................................................................................166 Overview...........................................................................................................................................166 Narrative therapy topics ....................................................................................................................167 Concept .........................................................................................................................................167 Narrative approaches.....................................................................................................................167 Common elements.........................................................................................................................168 Method ..........................................................................................................................................168 Outsider Witnesses........................................................................................................................168 Definitions.........................................................................................................................................170 The identified patient ....................................................................................................................170 Homeostasis (Balance)..................................................................................................................170 The extended family field. ............................................................................................................170 Differentiation...............................................................................................................................170 Triangular relationships ................................................................................................................170 Multisystemic Therapy..................................................................................................................170 Calibration:....................................................................................................................................170 Family Life Cycle: ........................................................................................................................171 Centrifugal/centripetal: .................................................................................................................171 Circular (mutual, reciprocal) causality:.........................................................................................171 Open/Closed systems: ...................................................................................................................171 14
  15. 15. Cybernetics:...................................................................................................................................171 Double bind...................................................................................................................................171 Equifinality / Equipotentiality:......................................................................................................171 First-order / Second-order change:................................................................................................171 Pseudo mutuality:..........................................................................................................................171 Punctuation:...................................................................................................................................172 Rules:.............................................................................................................................................172 Criticisms of Narrative Therapy........................................................................................................172 See also..............................................................................................................................................172 Theoretical foundations.................................................................................................................172 Related types of therapy................................................................................................................172 Other related concepts...................................................................................................................172 References.........................................................................................................................................172 We do not tell stories only: we are stories. .......................................................................................173 Basic Techniques in Family Therapy ................................................................................................174 OBSERVATION...............................................................................................................................174 IDENTIFICATION...........................................................................................................................174 I/ INFORMATION-GATHERING TECHNIQUES.........................................................................175 GETTING INFORMATION THROUGH USING OPEN-ENDED QUESTIONS. ....................175 THE GENOGRAM.......................................................................................................................175 THE FAMILY FLOORPLAN ......................................................................................................176 FAMILY PHOTOS.......................................................................................................................176 II/ JOINING ......................................................................................................................................177 1) TRACKING:.............................................................................................................................177 2) MIMESIS:.................................................................................................................................177 3) CONFIRMATION OF A FAMILY MEMBER:......................................................................177 4) ACCOMMODATION:.............................................................................................................177 III/ DIAGNOSING...........................................................................................................................177 IV/ FAMILY SYSTEM STRATEGIES ..........................................................................................178 ASKING PROCESS QUESTIONS. .............................................................................................178 FAMILY SCULPTING ................................................................................................................178 FAMILY CHOREOGRAPHY......................................................................................................178 V/ INTERVENTION TECHNIQUES ..............................................................................................179 RELATIONSHIP EXPERIMENTS..............................................................................................179 COACHING..................................................................................................................................179 I-POSITIONS................................................................................................................................179 DISPLACEMENT STORIES. ......................................................................................................179 TAKING SIDE & MEDIATING..................................................................................................180 THE EMPTY CHAIR...................................................................................................................180 FAMILY COUNCIL MEETINGS ...............................................................................................180 STRATEGIC ALLIANCES..........................................................................................................180 PRESCRIBING INDECISION.....................................................................................................180 PUTTING THE CLIENT IN CONTROL OF THE SYMPTOM.................................................180 SPECIAL DAYS, MINI-VACATIONS, SPECIAL OUTINGS ..................................................181 PROBLEM SOLVING .................................................................................................................181 15
  16. 16. FAMILY CONTRACTS...............................................................................................................181 REFRAMING ...............................................................................................................................181 PUNCTUATION ..........................................................................................................................182 UNBALANCING .........................................................................................................................183 RESTRUCTURING......................................................................................................................183 ENACTMENT ..............................................................................................................................183 BOUNDARY FORMATION .......................................................................................................183 WORKING WITH SPONTANEOUS INTERACTION ..............................................................183 INTENSITY..................................................................................................................................183 SHAPING COMPETENCE..........................................................................................................183 ADDING COGNITIVE CONSTRUCTIONS ..............................................................................183 VI/ COMMUNICATION SKILL BUILDING TECHNIQUES.......................................................184 REFLECTING ..............................................................................................................................184 REPEATING.................................................................................................................................184 FAIR FIGHTING..........................................................................................................................184 TAKING TURNS EXPRESSING FEELINGS ............................................................................184 NONJUDGMENTAL BRAINSTORMING.................................................................................184 EFFECTIVE COMMUNICATION..............................................................................................185 Problem - Centered Systems Family Therapy..................................................................................186 Stages and Steps of Therapy .............................................................................................................186 Assessment....................................................................................................................................186 Contracting....................................................................................................................................186 Treatment ......................................................................................................................................186 Closure ..........................................................................................................................................186 A Guideline for Family Assessment .................................................................................................186 1. Orientation.................................................................................................................................186 2. Data Gathering ..........................................................................................................................186 3. Problem List..............................................................................................................................186 4. Problem Clarification................................................................................................................186 Summary of Dimension Concepts ....................................................................................................187 Problem-solving ............................................................................................................................187 Seven stages to the process ...........................................................................................................187 Communication.............................................................................................................................187 Roles..............................................................................................................................................187 Other family functions: .................................................................................................................187 Affective Responsiveness .............................................................................................................187 Affective Involvement ..................................................................................................................187 Behavior Control...........................................................................................................................187 Structure of a Family Therapy Session.............................................................................................188 Instructions........................................................................................................................................188 1. Research and Background.........................................................................................................188 2. Family Session ..........................................................................................................................188 Structure of Family Therapy .............................................................................................................189 A. Assumptions.................................................................................................................................190 B. Salvador Minuchin .......................................................................................................................190 C. Theoretical formulations - three essential constructs ...................................................................190 16
  17. 17. D. Normal family development.........................................................................................................191 E. The development of behaviour disorders .....................................................................................191 F. Goals of therapy............................................................................................................................191 G. Techniques — join, map, transform structure..............................................................................191 1. Joining and accommodating, then taking a position of leadership ...........................................191 2. Enactment for understanding and change .................................................................................191 3. Working with interaction and mapping the underlying structure .............................................191 4. Diagnosing ................................................................................................................................191 5. Highlighting and modifying interpersonal interactions is essential..........................................191 6. Boundary making and boundary strengthening ........................................................................192 7. Unbalancing may be necessary .................................................................................................192 8. Challenging the family’s assumptions may be necessary.........................................................192 9. Therapists must create techniques to fit each unique family ....................................................192 17
  18. 18. Systemic Family Therapy Manual.....................................................................................................197 1. Introduction...................................................................................................................................197 1.1 Origins of the Manual .............................................................................................................197 1.2 Aims and applicability of the manual .....................................................................................197 1.3 Notes on use of manual...........................................................................................................197 1.4 Ethical & Culturally Sensitive Practice..................................................................................198 1.5 Clinical Examples ............................................................................................................198 2. Guiding Principles.........................................................................................................................199 2.1 Systems Focus.........................................................................................................................199 2.2 Circularity ...............................................................................................................................199 2.3 Connections and Patterns ........................................................................................................199 2.4 Narratives and Language.........................................................................................................199 2.5 Constructivism ........................................................................................................................199 2.6 Social Constructionism ...........................................................................................................199 2.7 Cultural Context......................................................................................................................199 2.8 Power.......................................................................................................................................200 2.9 Co-constructed therapy ...........................................................................................................200 2.10 Self-Reflexivity.....................................................................................................................200 2.11 Strengths and Solutions.........................................................................................................200 3. Outline of Therapeutic Change .....................................................................................................201 3.1 Models of Therapeutic Change ...............................................................................................201 3.2 Overview of Specific Goals ....................................................................................................202 4. Outline of Therapist Interventions ................................................................................................203 4.1 Linear Questioning..................................................................................................................203 4.2 Circular Questions...................................................................................................................203 4.3 Statements ...............................................................................................................................204 4.4 Reflecting Teams ....................................................................................................................204 4.5 Child Centred Interventions ....................................................................................................206 5. Therapeutic Setting .......................................................................................................................207 5.1 Convening Sessions ................................................................................................................207 5.2 Team........................................................................................................................................207 5.3 Video.......................................................................................................................................207 5.4 Pre-therapy preparation...........................................................................................................207 5.5 Pre & Post Session Preparation...............................................................................................208 5.6 Correspondence.......................................................................................................................209 5.7 Case notes................................................................................................................................209 5.8 Session notes ...........................................................................................................................209 6. Initial sessions ...............................................................................................................................210 Goals during initial session ...........................................................................................................210 6.1. Outline Therapy Boundaries & Structure ..............................................................................210 6.2 Engage and Involve all family members.................................................................................211 6.3 Gather and Clarify Information...............................................................................................211 6.4 Establish Goals and Objectives of Therapy ............................................................................211 Initial Session Checklist for Therapists.........................................................................................212 7. Middle Sessions ............................................................................................................................213 Goals during middle sessions........................................................................................................213 18
  19. 19. 7.1 Develop engagement...............................................................................................................213 7.2 Gather Information & Focus Discussion.................................................................................213 7.3 Identify & Explore Beliefs......................................................................................................213 7.4 Work towards change at the level of beliefs and behaviours..................................................215 7.5 Return to Objectives and Goals of Therapy............................................................................220 Middle Sessions Checklist for Therapists.....................................................................................220 8. End Sessions.................................................................................................................................222 Goals during ending sessions........................................................................................................222 8.1 Gather Information & Focus Discussion.................................................................................222 8.2 Continue to work towards change at the level of behaviours and beliefs..............................222 8.3 Develop family understanding about behaviours and beliefs ...........................................223 8.4 Collaborative ending decision..........................................................................................223 8.5 Review the process of therapy ................................................................................................224 End Sessions Checklist for Therapists ..........................................................................................224 9. Indirect Work ................................................................................................................................225 9.1 Child Protection ......................................................................................................................225 9.2 Clarifying therapy with referrer present..................................................................................225 9.3 Identifying the network and clarifying relationships ..............................................................226 9.4 Assessing risk..........................................................................................................................226 10. Proscribed Practices ....................................................................................................................227 10.1 Advice ...............................................................................................................................227 10.2 Interpretation.........................................................................................................................227 10.3 Un-transparent/Closed Practice.............................................................................................227 10.4 Therapist monologues ...........................................................................................................227 10.5 Consistently siding with one person .....................................................................................227 10.6 Working in the transference..................................................................................................227 10.7 Inattention to use of language ...............................................................................................227 10.8 Reflections.............................................................................................................................227 10.9 Polarised position..................................................................................................................227 10.11 Sticking in one time frame ............................................................................................228 10.12 Agreeing / not challenging ideas...................................................................................228 10.13 Ignoring information that contradicts hypothesis ...............................................................228 10.14 Dismissing ideas..................................................................................................................228 10.15 Inappropriate affect .............................................................................................................228 10.16 Ignoring family affect .........................................................................................................228 10.17 Ignoring difference..............................................................................................................228 APPENDIXES......................................................................................................................................229 Appendix 1: Sample Appointment Letter...........................................................................................229 Appendix II: Sample Video Consent Form.........................................................................................230 Appendix III: Sample Referrer letter..................................................................................................231 Appendix IV: Post-assessment letter ................................................................................................232 Appendix V: Closing letter to referrer ..............................................................................................233 Appendix VI : Session Notes Record Form......................................................................................234 Appendix VII – Diagonistic Interview Outline.................................................................................236 19
  20. 20. BASIC FAMILY THERAPY TECHNIQUES .................................................................................239  ACCOMMODATION ..............................................................................................................239  ADVICE & INFORMATION...................................................................................................239  AFFECTIVE CONFRONTATION ..........................................................................................239  ASKING PERMISSION...........................................................................................................240  BEGINNER’S MIND ...............................................................................................................240  BOUNDARY FORMATION ...................................................................................................240  ADDING COGNITIVE CONSTRUCTIONS ..........................................................................241 1.Advice & Information............................................................................................................241 2. Pragmatic fictions..................................................................................................................241 3. Paradox..................................................................................................................................241  COMMUNICATION TECHNIQUES......................................................................................241 1. MATCHING THE CLIENT’S LANGUAGE ......................................................................241 2. MATCHING SENSORY MODALITIES.............................................................................241 3. CHANNELING THE CLIENT’S LANGUAGE..................................................................241 4. USE OF VERB FORMS.......................................................................................................241 5. GIVE CLOSE EXAMINATION TO THEIR LANGUAGE AND YOURS........................241  COMMUNICATION SKILL-BUILDING TECHNIQUES.....................................................242 1. REFLECTING ......................................................................................................................242 2. REPEATING.........................................................................................................................242 3. FAIR FIGHTING TECHNIQUES........................................................................................242  CONCLUSION.........................................................................................................................242  CONFIRMATION OF A FAMILY MEMBER: ......................................................................242  DEFRAMING...........................................................................................................................242  DETRIANGULATION.............................................................................................................244  DIAGNOSING..........................................................................................................................244  DIFFERENTIATION OF SELF...............................................................................................244  DISEQUILIBRIUM TECHNIQUES........................................................................................244 1. REFRAMING: ......................................................................................................................244 3. BOUNDARY MAKING.......................................................................................................246 4. PUNCTUATION: .................................................................................................................247 4. UNBALANCING: ................................................................................................................247  LESSONS IN EFFECTIVE COMMUNICATION ..................................................................248  EMOTIONAL CUT-OFF .........................................................................................................249  THE EMPTY CHAIR...............................................................................................................250  ENACTMENT ..........................................................................................................................250  FAMILY CHOREOGRAPHY..................................................................................................250  FAMILY CONTRACT.............................................................................................................250  FAMILY COUNCIL MEETINGS ...........................................................................................250  FAMILY FLOOR PLAN..........................................................................................................251  FAMILY LIFE CYCLE............................................................................................................251  FAMILY PHOTOS...................................................................................................................251  FAMILY SCULPTING ............................................................................................................251  FAMILY SYSTEM STRATEGIES..........................................................................................252  THE GENOGRAM...................................................................................................................252  GOAL SETTING......................................................................................................................252  ICEBREAKER COMPLIMENT OR POSITIVE STATEMENT ............................................252  IDENTIFICATION...................................................................................................................253  INFORMATION-GATHERING TECHNIQUES....................................................................253 1. The Genogram.......................................................................................................................253 20
  21. 21. 2. Family Photos........................................................................................................................253 3. Family Floorplan...................................................................................................................253  INTENSITY..............................................................................................................................253  INTERVENTION TECHNIQUES ...........................................................................................253  INVOLUNTARY CLIENT SHEMA .......................................................................................253  JOINING...................................................................................................................................255  1. Tracking: ...........................................................................................................................255  2. Mimesis:............................................................................................................................255  3. Confirmation of a family member: ...................................................................................255  4. Accommodation:...............................................................................................................255  5. Maintenance ......................................................................................................................256  NORMALIZATION .................................................................................................................256  OBSERVATION.......................................................................................................................258  POSITIVE CONNOTATION...................................................................................................258  PARADOXICAL INJUNCTIONS ...........................................................................................259  PRAGMATIC FICTIONS ........................................................................................................259  PRESCRIBING INDECISION.................................................................................................259  PROBLEM TRACKING ..........................................................................................................260  PROBLEM SOLVING TECHNIQUES ...................................................................................260  PROBLEM DISSOLUTION ....................................................................................................260  PUNCTUATION ......................................................................................................................260  PUTTING CLIENT IN CONTROL OF THE SYMPTOM......................................................260  QUESTIONS.............................................................................................................................261 1. THE MIRACLE QUESTION:.............................................................................................261 2. FAST-FORWARDING QUESTIONS .................................................................................261 3. THE EXCEPTION QUESTION:.........................................................................................261 4. STRATEGIC BASIC QUESTIONS:....................................................................................261 5. PROVOCATIVE QUESTIONS: ..........................................................................................261 6. SCALING QUESTIONS AND PERCENTAGE QUESTIONS ..........................................261 7. EXCEPTION SEEKING QUESTIONS ...............................................................................262 8. COPING QUESTIONS.........................................................................................................262 9. OPEN QUESTIONS .............................................................................................................263 10. PROCESS QUESTIONS. ..................................................................................................264 11. LINEAR QUESTIONS......................................................................................................264 12. CIRCULAR QUESTIONS .................................................................................................264 15. PROBLEM TRACKING QUESTIONS.............................................................................268 16. CONVERSATIONAL QUESTIONS ................................................................................270 17. FRAMING QUESTIONS ...................................................................................................272 18. DEFRAMING QUESTIONS..............................................................................................272  REFRAMING ...........................................................................................................................272  REFRAMING PROBLEM DEFINITIONS .............................................................................272  RESTRUCTURING..................................................................................................................273  SHAPING COMPETENCE......................................................................................................273  USE OF SILENCE....................................................................................................................273  SPECIAL DAYS, MINI-VACATIONS, SPECIAL OUTINGS ..............................................274  WORKING WITH SPONTANEOUS INTERACTION ..........................................................274  STRATEGIC ALLIANCES......................................................................................................274  TRACKING ..............................................................................................................................274  UNBALANCING .....................................................................................................................275  INTRODUCING UNCERTAINTY..........................................................................................275  UTILIZATION STRATEGY....................................................................................................275 21
  22. 22. Summary of Family Therapy Theories & Techniques ....................................................................282 Family Therapy Survey ......................................................................................................................282 I. The Foundations of Family Therapy - Outline by David Peers.....................................................282 A. The myth of the hero ................................................................................................................282 B. Psychotherapeutic sanctuary ....................................................................................................282 C. Family vs. Individual therapy...................................................................................................282 D. Psychology and social context .................................................................................................282 E. The power of family therapy ....................................................................................................283 F. Contemporary cultural influences.............................................................................................283 G. Thinking in lines vs. Thinking in circles..................................................................................283 II. The Evolution Of Family Therapy - Outline by Lori Rice...........................................................284 A. The undeclared war ..................................................................................................................284 B. Small group dynamics ..............................................................................................................284 C. Child guidance movement........................................................................................................284 D. The influence of social work....................................................................................................284 E. Research on family dynamics and the etiology of schizophrenia.............................................284 III. Early Models And Basic Techniques - Outline by Sarah Sifers:................................................285 A. Family therapy has a history of being condescending .............................................................285 B. Sketches of leading figures.......................................................................................................285 C. Theoretical formulations - group..............................................................................................285 D. Theoretical formulations - communications ............................................................................285 E. Normal family development.....................................................................................................286 F. Development of behavior disorders..........................................................................................286 G. Goals of therapy .......................................................................................................................286 H. Conditions for behavior change ...............................................................................................286 I. Techniques of group family therapy..........................................................................................286 J. Techniques of communications family therapy.........................................................................286 K. Lessons from early models.......................................................................................................287 L. System’s anxiety.......................................................................................................................287 M. Stages of family therapy..........................................................................................................287 N. Family assessment....................................................................................................................287 O. Working with managed care - it’s necessary, so cooperate .....................................................287 IV. The Fundamental Concepts Of Family Therapy - Outline by Anabella Pavon.........................288 A. Conceptual influences on the evolution of family therapy ......................................................288 B. Enduring concepts and methods...............................................................................................289 V. Bowen Family Systems Therapy - Outline by Jared Warren......................................................290 A. Sketches of leading figures ......................................................................................................290 B. Theoretical formulations ..........................................................................................................290 C. Normal family development.....................................................................................................290 D. Development of behaviour disorders .......................................................................................291 E. Goals of therapy........................................................................................................................291 F. Conditions for behavior change................................................................................................291 G. Techniques ...............................................................................................................................291 H. Evaluating therapy theory and results ......................................................................................291 I. Summary - Seven prominent techniques ...................................................................................291 22
  23. 23. VI. Experiential Family Therapy Outline by Sarah Sifers................................................................292 A. Leading figures and background..............................................................................................292 B. Theoretical formulations ..........................................................................................................292 C. Normal family development.....................................................................................................292 D. Development of behavior disorders .........................................................................................292 E. Goals of therapy........................................................................................................................293 F. Conditions for behavior change................................................................................................293 G. techniques.................................................................................................................................293 H. Evaluation.................................................................................................................................293 VII. Psychoanalytic Family Therapy Outline by Anabella Pavon....................................................294 A. Introduction ..............................................................................................................................294 B. Sketches of leading figures.......................................................................................................294 C. Theoretical formulations ..........................................................................................................294 D. Normal family development.....................................................................................................294 E. Development of behavior disorders..........................................................................................295 F. Goals of therapy........................................................................................................................295 G. Conditions for behavior change ...............................................................................................295 H. Techniques ...............................................................................................................................295 VIII. Structure Family Therapy — Outline by Patty Salehpur .........................................................296 A. Assumptions.............................................................................................................................296 B. Salvador Minuchin ...................................................................................................................296 C. Theoretical formulations - three essential constructs ...............................................................296 D. Normal family development.....................................................................................................296 E. The development of behavior disorders ...................................................................................296 F. Goals of therapy........................................................................................................................297 G. Techniques — join, map, transform structure..........................................................................297 23
  24. 24. 24
  25. 25. Family Therapy – Background Information From Wikipedia, the Free Encyclopedia Family therapy, also referred to as couple and family therapy and family systems therapy, is a branch of psychotherapy that works with families and couples in intimate relationships to nurture change and development. It tends to view change in terms of the systems of interaction between family members. It emphasizes family relationships 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 the problem, and regardless of whether the clients consider it an "individual" or "family" issue, involving families in solutions is often beneficial. This involvement of families is commonly accomplished by their direct participation in the therapy session. The skills of the family therapist thus include the ability to influence conversations in a way that catalyzes the strengths, wisdom, and support of the wider system. In the field's early years, many clinicians defined the family in a narrow, traditional manner usually including parents and children. As the field has evolved, the concept of the family is more commonly defined in terms of strongly supportive, long-term roles and relationships between people who may or may not be related by blood or marriage. Family therapy has been used effectively in the full range of human dilemmas; there is no category of relationship or psychological problem that has not been addressed with this approach. The conceptual frameworks developed by family therapists, especially those of family systems theorists, have been applied to a wide range of human behaviour, 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 25
  26. 26. History of Marital Therapy Guman &Fränkel 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 people coming to therapy attribute their problems to relationship issues. (Gurman, A. S. & Fraenkel, P. (2002). The history of couple therapy: A millennial review. Family Process, 41, 199-260.) G&F define Four Phases in the History of Couples Therapy: Phase I - 1930 to 1963 - Atheoretical  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 analysis Phase II - 1931 to 1966 - Psychoanalytic 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 weren't innovative or particularly effective Phase III - 1963 to 1985 - Family 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. 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 parts Phase IV - 1986 to now - Refining and Integrating  1986 was the publication of G&K book  New Theories were tried and refined, like Behavioural 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.  http://www.psychpage.com/family/library/history_of_couples_therapy.html 26

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