chapter 6 theories.pdf

197
c h a p t e r
6
Experiential Family Therapies
Learning Objectives
●
● Theory:
●
■
●
■
●
■
●
■
●
■
●
● Case conceptualization and treatment plan:
●
● Research:
●
● Diversity:
●
● Cross-theoretical comparison:
Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-203

198 Chapter 6 ● experiential Family therapies
Life is not the way it’s supposed to be. It’s the way it is. The way you cope with it is what
makes the difference.
—Virginia Satir
Lay of the Land
● The Satir model:
● Emotionally focused therapy (EFT):
● Symbolic–experiential therapy:
Shared Assumptions and Practices
in Experiential Approaches
Targeting Emotional Transactions
behavioral
affective emotional
Warmth, Empathy, and the Therapist’s Use of Self
Individual and Family Focus

the Satir Model 199
The Satir Model
In a Nutshell: The Least You Need to Know
Virginia Satir
The Juice: Significant Contributions to the Field
If you remember one thing from this chapter, it should be the following:
Communication Stances
communication stances
congruent communication,
self others
context.
Used
with
permission
of
the
Virginia
Satir
Global
Network
www.satirglobal.
org.
All
rights
reserved.

Survival Stances
Placating Stance
placators
disagrees
Blaming Stance
Congruent
Context Other
Self
Placator
Self
Context Other

The Satir Model 201
Superreasonable Stance
Irrelevant Stance
Blamer
Self
Other
Context
Superreasonable
Self
Other
Context

Rumor Has It: The People and Their Stories
Virginia Satir
Conjoint Family Therapy
John Banmen
The Big Picture: Overview of Treatment
second-order change
Try It Yourself
With a partner or on your own, identify the survival communication stances that
each member of your family of origin used when there was a loss of relational
safety. What contexts or situations are most likely to trigger you to feel unsafe
and revert to your survival stance? In what contexts have you learned to maintain
congruent communication even when you feel threatened?
Irrelevant
Self
Context Other

the Satir Model 203
1. Status quo:
2. Introduction of foreign element: foreign element
3. Chaos: positive feedback
4. Integration of new possibilities:
5. Practice:
6. New status quo:
Making Connections: The Therapeutic Relationship
Humanistic and Systemic Foundations
humanistic systemic
guide
Therapeutic Presence: Warmth and Humanity
Assumptions of sAtir’s model
1. People naturally tend toward positive growth (humanistic principle).
2. All people possess the resources for positive growth (humanistic principle).
3. Every person and every thing or situation impacts and is impacted by everyone and every-
thing else (systemic principle).
4. Therapy is a process that involves interaction between a therapist and a client; in this rela-
tionship, each person is responsible for himself/herself (systemic and humanistic principle).

therapeutic pres-
ence,
congruent
Making Contact
making contact
self-mandala:
●
●
●
●
Try It Yourself
When are you able to make authentic contact as Satir describes? Describe rela-
tionships in which you feel most authentic and able to fully connect with another.
Why does this connection matter? What helps you to “make contact” with others?
Empathy
empathy,
like

the Satir Model 205
Conveying Hope
Establishing Credibility
The Viewing: Case Conceptualization and Assessment
Assessment of fAmily functioning
● Role of the symptom in the system: Describe how the symptom main-
tains the family’s homoeostasis at an emotional level, often regulating
closeness and distance.
● Family dynamics: Identify salient dynamics:
●
■ power struggles
●
■ parental conflicts
●
■ Lack of validation
●
■ Lack of intimacy
● Family roles: Identify possible family roles:
●
■ the martyr
●
■ the victim or helpless one
●
■ the rescuer
●
■ the good child or parent
●
■ the bad child or parent
● Family life chronology: Describe key historical events, deaths, births,
divorces, major life changes.
● Survival triad: Describe the emotional and nurturing relationships be-
tween each child and parents.

Role of the Symptom in the System
Family Dynamics
● Power struggles:
● Parental conflicts:
● Lack of validation:
● Lack of intimacy:
Family Roles
●
●
●
Assessment of individuAl functioning
● Survival stances: Identify the survival stance of each person in the
system:
●
■ placator
●
■ Blamer
●
■ Superreasonable
●
■ Irrelevant
●
■ Congruent
● Six levels of experience: The iceberg: For symptomatic behavior,
describe:
●
■ Behavior
●
■ Coping
●
■ Feelings
●
■ perceptions
●
■ expectations
●
■ Yearnings
● Self-worth and self-esteem: Describe each person’s level of self-worth.
● Mind–body connection: Describe any salient mind–body connections.

the Satir Model 207
●
●
Family Life Chronology
family life chronology
●
●
●
Survival Triad
survival triad
Survival Stances
Six Levels of Experience: The Iceberg
six levels of experience transform
iceberg,
intrapsychic congruence
● Behavior:
● Coping:
● Feelings:
● Perceptions:
● Expectations:
● Yearnings:

yearnings percep-
tions expectations
Self-Worth and Self-Esteem
self-worth self-esteem
aspects of the self values
self-compassion,
Mind–Body Connection
symbolically functionally.
● Congruent communication and self-esteem:
● Placating:
● Blaming:
● Superreasonable:
● Irrelevant:
Try It Yourself
With a partner or on your own, identify a recent stressful event that made you feel
strong negative emotion of some kind. Use the iceberg to describe the multiple
layers of experience related to the one event. Are some levels incongruent with
other layers? Does identifying the different layers of experience help you under-
stand the situation differently? Do you see any new options?

the Satir Model 209
Targeting Change: Goal Setting
1.
2.
Relationally Focused Goals: Congruent Communication
congruent communication
Individually Focused Goals: Self-Actualization
exAmples of relAtionAlly focused goAls
● Increase congruent communication in relationships with spouse,
parent, child, etc.
● Change family rules and shoulds to general guidelines.
exAmples of individuAlly focused goAls
● Increase sense of self-worth and self-compassion.
● reduce defensiveness and use of survival stances.

The Doing: Interventions
Therapist’s Self
Ingredients of an Interaction
ingredients of an interac-
tion
1. What do I HEAR AND SEE?
2. What MEANINGS do I make of what I hear and see?
3. What FEELINGS do I have about the meanings I make?
4. What FEELINGS do I have ABOUT THESE FEELINGS?
congruent:
incongruent:
5. What DEFENSES do I use?
6. What RULES FOR COMMENTING do I use?
7. What is my RESPONSE in the situation?

the Satir Model 211
Facilitating Emotional Expression
Examples:
●
●
■
●
■
●
●
■
●
■
Softening Family Rules
guidelines.
Communication Enhancement: Coaching, Role Play, and Enactment
common AreAs of communicAtion coAching
● ask clients to start statements using “I” rather than “You.”
● ask clients to take full responsibility for their feelings rather than
blaming others (e.g., “Instead of ‘You made me feel . . .,’ try ‘When X
happened, I felt . . .’”).
● encourage clients to be direct and honest rather than expecting the
other to read between the lines.
● Identify double binds (e.g., “You asked your husband to show more
affection, but when he does, you are upset and say he only did so be-
cause you asked”).

Sculpting, or Spatial Metaphor
family sculpting
see
Touch
each other

the Satir Model 213
Interventions for Special Populations
Family Reconstruction: Group Intervention
family reconstruction
●
●
●
Parts Party
parts party
Scope It Out: Cross-Theoretical Comparison
Theoretical Conceptualization
Goal Setting
Facilitating Change

Putting It All Together: Satir Case Conceptualization
and Treatment Plan Templates
Areas for Theory-Specific Case Conceptualization: Satir
cases
to inform their treatment plan.
Communication and Validation Patterns
●
●
●
Relational Life Chronology
Relational and Family Dynamics
●
●
●
●
●
Role of the Symptom in the System
TreaTmenT Plan TemPlaTe for IndIvIdual wITh dePressIon/anxIeTy:
saTIr

putting It all together: Satir Case Conceptualization and treatment plan templates 215
Satir Treatment Plan: Client Goals with Interventions
Early-Phase Client Goal
1. survival stance
a. ingredients-of-interaction
b. Facilitate emotional expression
Working-Phase Client Goals
1. shoulds expectations
a. ingredients-of-interaction shoulds
b. Sculpt
2. perceptions, attitudes, and beliefs sense of self
a. Soften family rules
b. Coach
3. yearnings for love and accep-
tance
a. ingredients-of-interactions
b. Role-play
Closing-Phase Client Goals
1. self-worth authentic
self
a. Sculpt
b. Coach
2. congruent communication in couple/family relations
a. Sculpt
b. Role-play
Treatment Tasks
1.
a. Make contact empathy therapeutic presence.
2.
a. survival stance, six levels of experience
self-worth.
b. relational dynamics, family roles, sur-
vival triad, family life chronology.
3.
a.
b. resources community

treAtment plAn templAte for distressed couple/fAmily: sAtir
Satir Treatment Plan: Client Goals with Interventions
1. survival stances
a. family sculpt
b. Coach direct communication of emotions.
1. expectations
a. ingredients-of-interaction
b. Sculpt
2. perceptions, attitudes, beliefs
a. Soften family rules
b. Coach
3. yearnings for love and accep-
tance
a. ingredients-of-interactions
b. Role-play
1. self-worth
authentic self
a. Sculpt
b.
2. congruent communication
a. Sculpt
b. Role-play
Treatment Tasks
1.
a. Make contact empathy therapeutic
presence.
2.
a. survival stance, six levels of
experience self-worth.
b. relational dynamics, family roles,
survival triad, family life chronology.

tapestry Weaving: Working with Diverse populations 217
3.
a.
b. resources family and community
Tapestry Weaving: Working with Diverse Populations
Cultural, Ethnic, and Gender Diversity
Asian Families

Hispanic Families
● Acknowledging cultural differences:
● Metaphors:
● Values:
●
■
●
■
●
■ Simpatia:
● Goal setting:
● Contextual issues:
Sexual and Gender Identity Diversity
Research and the Evidence Base: Satir Model

emotionally Focused therapy (eFt) 219
client’s
Emotionally Focused Therapy (EFT)

Attachment and Adult Love
humans
need secure attachment relationships across the life span, not just in infancy and early
childhood.
1. Attachment is an innate motivating force.
2. Secure dependence complements autonomy.
3. Attachment offers an essential safe haven.
4. Attachment offers a secure base.
5. Emotional accessibility and responsiveness build bonds.

6. Fear and uncertainty activate attachment needs.
7. The process of separation distress is predictable.
This distress is experienced as a primal survival need, thus helping to explain—but
justify—the often extreme and cruel acts committed in the name of love.
8. There are a finite number of insecure attachment styles.
●
■ Anxious and hyperactivated:
●
■ Avoidance:
●
■ Combination anxious and avoidant:
9. Attachment involves working models of self and other.
10. Isolation and loss are inherently traumatizing.
Rumor Has It: The People and Their Stories
Susan Johnson
Les Greenberg
Emotion-
Focused Couple Therapy: The Dynamics of Emotion, Love, and Power
Courtesy
of
Sue
Johnson

Stage 1: De-Escalation of Negative Cycles
Step 1:
Step 2:
Step 3:
Step 4:
Stage 2: Change Interactional Patterns and Creating Engagement
Step 5:
Step 6:
Step 7:
Note:
Stage 3: Consolidation and Integration
Step 8:
Step 9:
with-
drawn
pursuer,

Task 1:
Task 2:
Task 3:
Making Connection: The Therapeutic Relationship
Empathetic Attunement
emotionally
Empathetic attunement
the client
Expression of Empathy: RISSSC
RISSSC
● Repeat:
● Images:
● Simple:
● Slow:
● Soft:
● Clients’ words:

●
●
●
Genuineness
Acceptance
as they are
Self-Disclosure
Continuous Monitoring of the Alliance
Joining the System
The Therapist’s Role
●
●
●

not
●
●
●
Intrapsychic and Interpersonal Issues
● Intrapsychic:
● Interpersonal:
Primary and Secondary Emotions
● Primary emotions: Primary emotions
● Secondary emotions: Secondary emotions about the primary emotions,
.
Negative Interaction Cycle: Pursue/Withdraw
negative interaction cycle
pursuer
withdrawer

● Pursue/withdraw:
● Withdraw/withdraw:
burned-out pursuer,
● Attack/attack:
● Complex cycles:
Attachment History
Try It Yourself
With a partner or on your own, identify the negative interaction pattern in your
current or a past relationship. Which of the four basic patterns best describes the
pattern? Identify each person’s observable behavior in the interaction and each
person’s primary and secondary emotions. Which attachment style best describes
each person’s behavior during the negative interaction?
Questions for Assessing AttAchment history
● Describe your parents’ relationship? Were they close? Did they regu-
larly express affection for one another? Did they fight and if so how?
Were they generally able to resolve their conflicts in a way that re-
stored harmony and safety in the family?
● When you were young, to whom did you turn to for comfort and nur-
turing? Was this source of comfort reliable?

Attachment Injury
attachment injuries
Initial Assessment Sessions
●
●
●
●
●
●
●
●
●
●
●
●
● Describe your relationship with your parents and significant childhood
caregivers? how did you know you were loved? Did you feel safe,
physically and emotionally? how was conflict or disappointment han-
dled? how was it resolved? Was there abuse or trauma?
● Describe significant love relationships in your adulthood. Did you feel
safe, cared for, and nurtured? Were there significant betrayals or other
trauma?
● Describe the early phases of your relationship when you felt more con-
nected to your partner. how accessible were each of you? how did
you show responsiveness? how did you engage one another? (Furrow
et al., 2011)

Contraindications to EFT
● Different agendas for the relationship and therapy:
● Separating couples:
● Abusive relationships:
● Untreated addiction:
Targeting Change: Goal Setting
●
●
●
The Doing: Interventions
Interventions by Stage of Therapy
Early-Phase Interventions for Deescalating and Identifying the Cycle
●
●
●
●
●
Working-Phase Interventions for Restructuring Interactions
●
●
●
●
●
Closing-Phase Interventions
●
●
●
●
Validation
validation

Reflecting Primary and Secondary Emotions
reflects
Tracking Interaction Patterns and Cycles
Evocative Responding: Reflections and Questions
evocative responding
tentatively,
Empathetic Conjecture and Interpretation
empathetic conjecture
seed
attachment
Heightening
Heightening

Attending to Nonverbal Communication
●
●
●
●
●
●
●
●
Reframing in Context of Cycle and Attachment Needs
Enactments, Restructuring, and Choreography
Common Prompts for Choreographing New Interactions
●
●
●
Try It Yourself
With a partner or on your own, practice reframing the negative interaction cycle
in the last “try it yourself” activity as the “problem” as if you were doing it for a
client to help them see the cycle, not each other, as the problem.

Blamer Softening
mini-theory of BlAmer softening events
1. Possible blamer reaching: Therapist invites blaming partner to reach toward with-
drawing partner after having blaming partner experience more vulnerable attachment
needs.
2. Processing fears of reaching: This is the most critical theme in the softening event.
The therapist helps process the blaming partner’s fears of reaching out to his or her part-
ner and being rejected yet again. During this process, therapists specifically explore fears
related to a negative view of self and others that have developed from prior failed bids for
affection.Therapists use the most heightening, evocative responses and empathetic conjec-
tures in this theme, with clients typically needing to reach an emotional processing “boiling
point” before successfully moving on to the enactment of the softening reach. Then, the
therapist reissues the invitation to make the softening reach, this time highlighting both the
attachment need and the newly processed fears related to reaching.
3. Actual blamer reaching: The therapist makes a directive statement to the blaming
partner to reach for the other using a very simple request: “Can you turn to your partner
and tell him how scary this is for you and let him know what you need right now?”
4. Supporting the softening blamer: The therapist stays active in the enactment and
then affirms the clients sense of vulnerability and the new position.
5. Processing with engaged withdrawer: Continuing to be actively involved in the
enactment, the therapist shifts to the withdrawer, again, validating the softened blamer in
third person—“your partner just took a huge risk just now”—and helps “set the stage”
for the withdrawer by focusing on the attachment significance of the blamer’s reaching out.
6. Engaged withdrawer reaches back with support: Finally, after heightening
the withdrawer’s emotional response, the withdrawer is able to respond with support to his
partner’s request.

1. Absence of attachment base in emotional reflections:
2. Attachment-related affect distance:
3. Overlooking attachment-related fears:
4. Internal views of self and other unacknowledged:
5. Interpersonal enactment failure: no softening reach:
Attachment Injury Resolution Model
AttAchment injury resolution model
Phase 1: Steps 1–4: Cycle Deescalation Related to Injury
1. Injured partner provides account of incident, including description of secondary emotions.
2. Offending partner provides account of the same incident with his or her description of sec-
ondary protective responses.
3. Injured partner, with the help of the therapist, unpacks the negative models of self and
partner and the attachment significant of the event.
4. Offending partner, with the help of the therapist, unpacks secondary emotions, negative
models of self and partner, and attachment significance of event.
Phase 2: Steps 5–6: New Cycles of Emotional Engagement
5. Injured partner shares primary vulnerable attachment related emotional expression; this
process includes an injury-specific blamer-softening process.
6. Offending partner is emotionally accessible and provides vulnerable expressions of respon-
sibility, apology, and own desire for attachment.
Phase 3: Steps 7–8: Reconsolidation of Frayed Bond
7. Injured party accepts apology and is receptive to the offending partner’s accessibility and
expression of partner’s attachment needs.
8. Offending partner provides responsiveness to the injured partner’s expression of attach-
ment needs. However, even if there is forgiveness at this point, reconciliation often requires
the injured party to witness behaviors that show the intention to restore trust and maintain
the relationship.

Putting It All Together: EFT Case Conceptualization and Treatment Plan Templates 233
Turning the New Emotional Experience into a New Response
Scope It Out: Cross-Theoretical Comparison
Theoretical Conceptualization
Goal Setting
Facilitating Change
Putting It All Together: EFT Case Conceptualization
and Treatment Plan Templates
Areas for Theory-Specific Case Conceptualization: EFT

Negative Interaction Cycle
●
●
●
●
Primary and Secondary Emotions
●
●
●
●
Sociocultural Factors
Attachment History
Attachment Injuries
●
Attachment Patterns
●
●
●
●
Potential Contraindications to EFT
●
●
●
●
treAtment plAn templAte for distressed couple/fAmily: eft

putting It all together: eFt Case Conceptualization and treatment plan templates 235
EFT Treatment Plan: Client Goals with Interventions
Initial Phase
1. negative interaction cycle primary emo-
tions
a. validation, reflecting emotions, evocative responding, empathic conjecture
b. Track the negative interaction cycle,
c. Reframe
Working Phase
1. Increase engagement and emotional expression
a. empathy, validation, conjecture
attachment needs
b. enactments acceptance
new interaction sequences.
2. Decrease criticism attach-
ment emotions
a. Heighten softening
b. enactments acceptance new interaction
sequences.
3. create a sense of
relational safety and bonding
a. Track the interaction cycle empathetic conjecture
b. enactments
Closing Phase
1. respond effectively
a. Track positive interaction cycles
b. Reframe attachment
needs.
2.
solidify a secure bond
a. direct expression of emotional needs.
b. new emotional experience
Treatment Tasks
1.
a. empathic attunement, RISSSC, genuineness
2.
a. negative interaction cycle, pursuer/distancer roles.
b. secondary and primary (attachment) emotions
c. attachment history, attachment injuries,
trauma
3.
a. appropriateness of EFT

b. Crisis assessment intervention(s):
c. Referral(s): resources family and community
Tapestry Weaving: Diversity Considerations
Ethnic, Racial, and Cultural Diversity
Gender Identity Diversity

research and the evidence Base: eFt 237
1. Reestablish a safe connection:
2. Differentiate the injured party’s primary emotions:
3. Reengagement:
4. Forgiveness and reconciliation:
Research and the Evidence Base: EFT

1.
2.
3.
Clinical Spotlight: Symbolic–Experiential Therapy
Symbolic–experiential therapy

Clinical Spotlight: Symbolic–experiential therapy 239
The Battle for Structure and the Battle for Initiative
battle for structure battle for ini-
tiative
therapist,
●
●
●
The key point here is for the therapist to face the need to act with personal and professional
integrity. You must act on what you believe. Betrayals help no one. The Battle for Structure is
really you coming to grips with yourself and then presenting this to them. It’s not a technique or
power play. It’s a setting of the minimum conditions you require before beginning.—Whitaker
& Bumberry, 1988, p. 54
initiative .
therapists should never work harder than their clients.
Therapy of the Absurd
perturb

Making Connections: The Therapeutic Relationship
Families do not fail, therapists do.—Whitaker and Ryan, 1989, p. 56
Therapist’s Authentic Use of Self
Personal Integrity
Therapists’ Responsibility
to
for
active
Stimulating Mutual Growth

Spontaneity, Play, and “Craziness”
Use of Cotherapists
Authentic Encounters and the Affective System
authentic encounters
emotional system
Trial of Labor
trial of labor

Assessing Structural Organization
● Permeable boundaries within the family:
● Clear boundaries with extended family and larger systems:
● Role flexibility:
● Flexible alliances and coalitions:
● Generation gap:
● Gender-role flexibility:
● Transgenerational mandates:
● “Ghosts”:
Assessing Emotional Process
● Differentiation and individuation:
● Tolerance of conflict:
● Conflict resolution and problem solving:
● Sexuality:
● Loyalty and commitment:
● Parental empathy:
● Playfulness, creativity, and humor:
● Cultural adaptations:
● Symbolic process:
QUESTIONS FOR PERSONAL REFLECTION AND CLASS DISCUSSION

ONLINE RESOURCES
www.avanta.net
http://www.satirpacific.org
http://www.satirtraining.org
http://www.satirinstitute.org
www.eft.ca
www.theeftzone.com
www.emotionfocusedtherapy.org
Contemporary Family
Therapy, 24,
Meditations of Virginia
Satir.
Journal of Family Psychotherapy, 25,
Family Journal 16
A secure base: Parent-
child attachment and healthy human
development.
Journal of Marital and Family
Therapy, 30,
REFERENCES

experiential Case Study: Child Sexual abuse 247
Dissertation Abstracts
International, 59,
The
emotionally focused casebook: New
directions in treating couples
Journal of Marital and
Family Therapy 39
Experiential Case Study: Child Sexual Abuse

SATIR HUMAN GROWTH MODEL CASE
CONCEPTUALIzATION
For use with individual, couple, or family clients.
Date: 4/15/18 Clinician: Sharee Lee Client/Case #: 1020
Introduction to Client & Significant Others
List all significant others for client:
Adults/Parents:
AM1: 36 Lawyer
Armenian American, second generation
AF1: 36
Lawyer Greek American, second generation; reports being diagnosed with
bipolar disorder but that it is currently managed with medicaiton.
CF1: 12 Greenwood School
Socially and academically engaged in school.
Presenting Concerns
Describe each significant person’s description of the problem:
Although he does not blame AF36 for the abuse, he is concerned about the weakening of
AF36’s relationship with CF12 over the past year or two due to her increased focus at work. Reports feel-
ing guilty that they made the decision to have AF work because “this might not have happened.” Feels
helpless in terms of knowing how to help CF12.
Blames self for abuse and feels guilty about pursuing her career; feels as though she
has no other choice. At the same time, she is angry that AM is not more supportive of her career, since
she has had been the priority for the most of CF12’s infancy and elementary school years.
Feels supported by parents and is relieved that her parents believed her; reports feel-
ing increasingly uncomfortable around her peers and less social; having nightmares and intrusive
thoughts. Feels somewhat neglected by mother since she started traveling more.
Broader System: Description of problem from extended family, referring party, school, legal system, etc.:
Extended Family: AF35 and AM36’s parents are supportive yet also hint that this could have been pre-
vented if AF36 stayed home with CF12 more rather than try to pursue a career.
© 2016. Diane R. Gehart, Ph.D. All rights reserved. www.masteringcompetencies.com

Believes CF12’s report and has referred her for therapy to
address trauma issues.
Background Information
Trauma/Abuse History Six months ago a female babysitter began molesting CF12,
which continue for almost two months before it escalated to a point where CF12 told her parents. Her
parents promptly made a report and swift action was taken by CPS.
Substance Use/Abuse No significant sub-
stance issues reported.
Precipitating Events AF36 began traveling more
for work a year ago, which necessitated hiring more babysitters for CF12 after school and on weekends.
AF36 and AM36 have been arguing more since she has been traveling, and her relationship with CF12
has reportedly weakened during this period also.
Related Historical Background
AF36 was diagnosed with bipolar, as was her mother and sister, and has had prior
therapy related to the mood disorder. She is currently taking medications and reports being stable.
There have been several divorces by AM36 and AF36’s siblings, which alarms them both.
Communication and Validation Patterns
Describe the communication and validation patterns for all significant persons related to client:
: Stance(s) when feels invalidated: □ □ ☒ □
Relational dynamics that triggers survival stance: Survival stance triggered when AM has to engage
difficult emotions in himself or other or when he feels attacked by AF or family of origin.
Relational/family belief or rule that informs this triggering dynamic: People should be logical and
make sense; men should not have to take care of the children; that is a woman’s job. Taking care of chil-
dren has less value than achieving at work.
Relational dynamics that enable person to communicate congruently: AM is generally able to be
congruent when discussing practical issues, such as work and child-care responsibilities, even when
having to solve practical problems.
Stance(s) when feels invalidated: □ ☒ □
□
Relational dynamics that triggers survival stance: Survival stance triggered when her needs are not
recognized in the family or when AM tries to make her feel guilty; also triggered by family of origin,
particularly her mother, when she feels they disapprove of her in some way.
Relational/family belief or rule that informs this triggering dynamic: One must be perfect and high
achieveing to have worth. It is not fair; everyone else has it easier than me.
continued

Communication and Validation Patterns (continued)
Relational dynamics that enable person to communicate congruently: When AF36 believes others
are not blaming her or when she is not silently blaming or doubting herself.
Stance(s) when feels invalidated: ☒ □ □
□
Relational dynamics that triggers survival stance: Whenever she feels disapproval from parents or
others.
Relational/family belief or rule that informs this triggering dynamic: One must be perfect and high
achieving to have worth.
Relational dynamics that enable person to communicate congruently With AM36 and AF36’s support
in conjunction with therapeutic services, CF12 can develop a voice to advocate for herself.
Stance(s) when feels invalidated: □ □ □
□
Relational dynamics that triggers survival stance: .
Relational/family belief or rule that informs this triggering dynamic: .
Relational dynamics that enable person to communicate congruently: .
Describe the dynamics of each person’s sense of self-worth and self-esteem, including contexts in
which each has greater or lesser sense of worth:
AM36 prides himself on his professional identity, which is the primarily source of his self-
worth. However, his recent need to participate more in CF12’s life while AF36 has been away has com-
promised his view of self, as his views of gender roles have been challenged.
AF36’s self-worth comes from both her professional success and—prior to the abuse—
from her role as a mother. However, her sense of self-worth was significantly impacted upon hearing
about abuse toward CF12. AF36’s identity as a mother has been called into question, and she feels
guilty for neglecting CF12 while on business trips, yet also is unable to justify stopping the pursuit of her
career.
CF12’s self-worth has been based on external sources—the approval of her parents and
on school achievement—and thus is not consistent or stable. The experience of abuse has done further
damage to her sense of worth and may be why she is avoiding her peers.

Describe dynamics of social location, such as cultural, gender, social class, or other diversity factors,
that inform evaluation of self: Since both AM36 and AF36 financially provide for family, the system’s gen-
der roles are nontraditional. AF36’s belief that she has duties to maintain both a strong professional identity
as well as a significant maternal role create a demanding lifestyle. Fortunately both parents’ incomes al-
low for financial stability and access to useful resources. As is common in second-generation European
immigrants from collectivist cultures (Greek and Armenian), both parents have a strong work ethic and
focus on the success of the next generation, much like their parents did for them. They have a strong sense
of connection to their broader ethnic community that also provides a sense of worth and meaning.
Relational Life Chronology
Describe significant events, specifically those that may relate to sense of validation and worth, in
family and/or relational life; please list in chronological order:
2004
CF12 born
Created family system and AM36 and AF36’s
roles as father and mother
2010
AM36 promoted
AM36’s professional identity strengthened
and validated
2014
AF36 promoted
AF36’s professional success threatened
AM36’s role as breadwinner and shifted
more child-care responsibilities to AM36
2015
Sexual abuse toward CF12
CF12 began to question her self-worth,
which led to difficulty engaging in positive
socialization at school
Relational/Family Dynamics
Describe salient dynamics:
☒ With both AM36 and AF36 as working parents, tradi-
tional gender roles are challenged and duties as breadwinner and child-caregiver must be negotiated.
☒ AM36 feels resentful for having to take on more child-care responsibili-
ties while AF36 is away on business, since he also works full-time.
☒ : Both
parents are able to show warmth to their daughter, although AF has been more distant through the

recent turmoil due to her own guilt; the couple struggles with showing the same level of warmth toward
each other because resentment and guilt have made it difficult for them to connect.
☒
☒ AF often describes herself as a martyr; in the past it was being a professional working
mother without help from husband. Now it is that she must travel for work.
☒ CF12’s placating stance contributes to her victimization and feeling incapable of
managing her life
□
□
☒ AM36 is the “good” parent for stepping in to take care of CF12, while AF36 is
the “bad” parent for engaging in increased work demands and neglecting family
□
Describe cultural, gender, social class, or other diversity factors that inform these dynamics: AM36
and AF36 are struggling to define gender roles as a duel career couple with demanding jobs. AM is
wanting more traditional Armenian gender roles, with his career the priority, and AF is wanting a more
American egalitarian relationship. She believes she had to sacrifice her career for the past 12 years
when CF was young; now that she is older, AF feels entitled to pursue her career.
Role of Symptom in System
Hypothesized homeostatic function of presenting problem: How might the symptom serve to main-
tain connection, create independence/distance, establish influence, reestablish connection, or other-
wise help create a sense of balance in the family? The abuse allegations have served as a stabilizing
mechanism that creates connection by distracting AM and AF from the power struggle within the mar-
riage regarding gender roles and the division of work/home labor and instead they are able to rally
together around the issue of protecting their daughter.
Relational/Family Dynamics (continued)

Experiential Case Study: Child Sexual Abuse 253
Legend
Male
Female
Enmeshed
Death
Conflicted
Conflictually
Enmeshed
Identified
Patient
Distant
Cut
Off
Divorce
12
Briana
Brad
Mood
Disorder
Died
in
Car
Accident
2005
Corporate
Manager
Nurse
Twins
Immigrated
from
Greece
1972
Armenian
At
Home
Baby
sitter
36
16
Sexual
Abuse
36
Sophie
Fire
Chief
Sexually
Abused
as
Child;
Bipolar
Dress
Designer
Bipolar
Energetic
Travels
for
Work
Sexually
Abused
as
Child
Bipolar
Lawyer
Pensive
Primary
Parent
Bright
Active
GenoGram

CLINICAL ASSESSMENT
Sharee Lee 1020 □ □ ☒ ☒ □
☒ Greek
Adult(s)
36 Lawyer Armenian
American, second generation
36 Lawyer
Greek American, second generation; reports being diagnosed with bipolor disorder
Child(ren)
12 Greenwood
Socially and academically engaged at school
Others:
Presenting Problem(s)
☒
□
□
☒
□
☒
□
□
□
☒
□
□
□
□
□
☒
□
☒ Nightmares; trauma
Complete for children:
☒
□
□
□
□
☒
☒
□
Mental Status Assessment for Identified Patient
Interpersonal □ □ □ ☒ □
□
Mood □ ☒ ☒ □ □ ☒ □
□
Affect □ ☒ □ □ □ □
□
Sleep □ □ □ ☒ ☒
□
Eating ☒ □ □ □ □ □
☒
Anxiety □ □ □ □ □ □
☒ Intrusive thoughts
Trauma
symptoms
□ ☒ ☒ □
☒ □
□

Experiential Case Study: Child Sexual Abuse 255
continued
Psychotic
symptoms
☒ □ □ □ □
□
Motor
activity/
speech
□ ☒ □ □ □ □
□ □ □
Thought □ □ □ □ □
☒ □ □ □ □
□ □
sociolegal ☒ □ □ □ □ □ □
□
□
Other
symptoms
☒
Diagnosis for Identified Patient
Contextual Factors ☒ ☒ ☒ ☒
☒ ☒ ☒ ☒ □ ☒ □
□ □ □ :
DsM-5 Level 1 Cross-Cutting symptom Measure (optional):
☒ □ □ ☒ □ □ □
☒ □ □ ☒ □ □
□
DsM-5 Code Diagnosis with specifier Include Z/T-Codes for Psychosocial Stressors/Issues
F43.10
Z69.020
Posttraumatic stress disorder
Encounter for mental health services for victim of nonparental child sexual abuse
List specific DsM-5 Criterion Met for Diagnosis
Life-threatening trauma: Sexually molested for 3 months
Intrusive thoughts and nightmares most days
Detachment from others; social withdrawal
Restricted affect
Exaggerated startle response; difficulty falling and staying asleep
Symptoms for more than 1 month
Medical Considerations
☒ □
☒ □ □
□ ☒
□
☒ □ □ □

Diagnosis for Identified Patient (continued)
Current Medications (psychiatric & medical) ☒
Medical Necessity: Check all that apply
☒ t ☒ ☒
Areas of impairment:
☒ ☒ □ ☒ □ □
Risk and Safety Assessment for Identified Patient
Suicidality
☒
□
□
□
□
□
□
□
Homicidality
☒
□
□
□
□
□
□
□
□
Alcohol Abuse
☒
□
□
Drug Use/Abuse
☒
□
□
□
Sexual & Physical Abuse and Other Risk Factors
☒ ☒ □ □ □
□ □ □ □
□ □ □ □
□
□
□ □ □
□
□
□
Indicators of Safety
□
☒
□
□
□
☒
□
☒
□
□
□
Elements of Safety Plan
□
□
□
☒
☒
□
□
□
☒
□
□

Case Management
Collateral Contacts
● physicians or other professionals: □ ☒ □
Pediatrician, Dr. Maria Garcia
● treatment elsewhere ☒ □ □
● social worker: □ ☒ □ Child protective services
assigned case worker, Danielle Garcia.
Referrals
● medical assessment ☒ □
● social services: ☒ □ □
□ □ □ □
● group □ □ ☒
● forensic/legal processes □ ☒ CPS case
Support Network
● ☒ □ ☒
☒ □ □
●●
Parents will participate in treatment.
●● Family dynamics must be addressed.
Expected Outcome and Prognosis
☒ □ □
Client Sense of Hope 6
Evaluation of Assessment/Client Perspective
Cre-
ated safe space for CF to talk; used age-appropriate language; asked about language preference; cultural norms for
emotional expression and family boundaries considered when making diagnosis and evaluating family; involved
family, honoring cultural norms for involvement.
Family agrees with PTSD diagnosis and agrees that “something” needs to change in family dynamics to get “back
on track.”
Legal/Ethical Action Taken: □ ☒ Report to Child Protective Services; report taken by Susan
Roth 7:30 pm 9/4/09

SATIR TREATMENT PLAN
Date: 04/10/2018 Case/Client #: 1020
Clinician Name: Sharee Lee Theory: Satir Growth Model
Modalities planned: □ ☒ ☒ ☒ □
Recommended session frequency: ☒ □ □
Expected length of treatment: 6
Treatment Plan with Goals and Interventions
sense of physical and emotional safety and sense of normalcy nightmares and
intrusive thoughts.
Measure: ☒ □
Explore mind–body connections and the six levels of experiencing related to CF’s abuse experi-
ence to help her identify how the abuse has affected her coping, feelings, feelings about those
feelings, perceptions, expectations and yearnings; also explore levels of experiencing for both
parents to help family members communicate and support one another.
Role-playing and sculpting to reinforce sense of being able to protect self and begin to envision
healing, including the use of touch to create a physical sense of safety within the family.
CF12 sense of safety and esteem in peer relationships social withdrawal and
depressed/anxious mood.
Measure: ☒
□ .
Analyze the ingredients of peer interactions to help identify beliefs from the abuse that may be
interfering with her peer relationships and then develop new ways to relate to peers.
Coaching and role play on how to interact with others and maintain safety and boundaries.
congruent communication and direct contact between CF12 and parents to reduce CF’s
depressed mood and anxiety.
Interventions:
Sculpting to enable family members to better understand how others experience them and to
help identify new and more satisfying ways of relating.
Coaching on congruent communication to help family more directly connect.
emotional engagement and congruent communication within marriage
triangulation and parental conflict and couple’s overfocus on CF.
Measure: ☒ □
Coaching couple to communicate congruently in session and “make contact” with each other.

Sculpting gender roles to help couple understand the emotional reality of the other and explore
more satisfying ways to divide labor and emotionally connect with partner; compare and con-
trast with gender roles in their parents’ and daughter’s generation to create three-generation
and cross-cultural perspective.
CF12’s sense of self-worth and agency as she enters adolescence low
self-esteem.
Measure: agency and worth □ ☒
placating
Use levels of experience (iceberg) to facilitate intrapsychic congruence and increase sense of
self-approval and decrease reliance on external definition of worth.
Sculpting various ways of being to enable CF to make more conscious life choices and to take
actions that enable her to be more congruent with who she wants to be.
cohesion of survival triad to create developmentally appropriate supportive relationship
with parents as CF transitions to adolescence conflict.
Measure: cohesion in survival triad □ ☒
Sculpt relationships highlight survival stance vs. congruent stance to experience the differ-
ence; sculpt family as they imagine it to be in 5 years to facilitate developmentally appropriate
family structure as CF enters adolescence.
Soften and redefine family roles about success, emotions, and how to define a person’s worth.
Treatment Tasks
Relationship building approach/intervention:
Make contact using warmth and empathy. Clearly establish hope that CF12 will have a normal
life and that therapy will help with that process.
Assessment strategies:
“Before and after” sculpting of each person’s perspective of how the family changed both rela-
tive to AF36 increasing travel and the abuse incidents.
Assess each member’s survival communication stance and how they are affecting individuals
and family since abuse; role of the symptom; family dynamics; chronology; quality of survival
triad; levels of experiencing; and self-worth of members.
Crisis assessment intervention(s): Reduce nightmares and other PTSD symptoms; monitor for
other crisis behavior throughout treatment.
Referral(s): Connect CF12 with available resources for abuse victims, including Victims of
Crime, and work with CPS and other authorities on reporting and investigation.
continued

Diversity Considerations
Age: Language appropriate to age and education level will be utilized.
Gender/Sexual Orientation: Particularly since this case involves sexual abuse, extra sensitivity will be
utilized when discussing CF12’s experiences and symptoms pertaining to presenting issue. The conflict
parents are experiencing related to gender roles will be addressed to help them emotionally reconnect
with one another.
Race/Ethnicity Religion/Class/Region: Therapeutic factors pertaining to multicultural family environ-
ment, which includes Armenian American and Greek American descent, will be considered, includ-
ing accessibility to emotional exploration, sensitivity to spiritual beliefs, traditionaly vs. contemporary
gender roles, and respect for elder generations. Additionally, the legacy of immigration and the related
family myths will be explored, including those related to socioeconomic success as primary life focus.
Other factors: The socioeconomic and ethnic/immigrant dynamics of CF’s school as well as the school
culture itself will be explored as part of helping CF adjust at school.
Evidence-Based Practice (Optional)
The
Satir approach has a strong evidence base for the quality of the therapeutic relationship, which is
strongly correlated with positive therapeutic outcomes. A warm, supportive relationship is particularly
important due to CF’s recent sexual abuse experience and should be a good cultural fit for the parents,
who are Greek and Armenian, cultures that typically have high emotional expression.
Client Perspective (Optional)
Has treatment plan been reviewed with client: ☒ □
Describe areas of Client Agreement and Concern: Clients are particularly enthusiastic about wanting
family sessions, especially early in therapy.

PROGRESS NOTE
Date: 5/12/2018 Time: 1:00 □ Session Length: □ ☒ □
Present: ☒ ☒ □ ☒ □
Billing Code: □ □ □ ☒
□
Symptoms(s) Duration and Frequency Since Last Visit Progress:
Progressing
Progressing
Progressing
Explanatory Notes on Symptoms: Report CF feeling “safer” and engaging more socially; intrusive
memories and nightmares less of an issue and CF is using techniques from prior weeks to manage. AF
still traveling for work but more open to finding ways to minimize the effect it has on CF and AM.
In-Session Interventions and Assigned Homework
Client Response/Feedback
Plan
□
☒ session next week to discuss gender roles and balancing work and home;
following week CF alone.
Next session 5/19 1:00 □ ☒
Crisis Issues: ☒ □
continued

SATIR PROGRESS NOTE continued
Case Consultation/Supervision □
Notes: Now that CF is more stabilized, supervisor encouraged separate couple and child sessions to
reinforce generational boundaries and allow CF to discuss more personal issues related to the abuse
in private.
Collateral Contact □
Name: □ □
☒ ☒ □ ☒ □
Notes: Returned social worker’s call; requested update on progress.

chapter 6 theories.pdf

Recommended

Recommended

More Related Content

What's hot

What's hot (20)

Similar to chapter 6 theories.pdf

Similar to chapter 6 theories.pdf (20)

Recently uploaded

Recently uploaded (20)

chapter 6 theories.pdf