This document discusses the background and issues facing a blended family consisting of Frank, Michelle, Ann, Lance, and Jessica. Frank and Michelle recently married but each brought children from previous relationships. Problems arose from feelings of guilt, jealousy, resentment, and unresolved grief that were exacerbated by the stress of becoming an instant family. Therapy focused on strengthening relationships within each family subsystem through activities and discussions. This led to positive structural and behavioral changes where the family became better integrated and each individual member was able to address their specific issues.

3. THE PRECURSORS
Freud - symptomatic behavior in neurotic individuals.
Adler – Family constellation
Sullivan – interpersonal relations view for families with schizophrenia.-
Ludwig von Bertalanffy (1968) – General systems theory and Circular causality
John Bell (1961) – Family group therapy
Bowen – Hospitalized families - family emotional systems.
Wynn – pseudomutuality – false sense of closeness
Nathan Ackerman – ‘The Psychodynamics of family life

4. SCHIZOPHRENIA
• Families were researched (1950)
• Bateson's Palo Alto group.
• Theodore Lidz
• National Institute of Mental Health – Bowen, Wynn.
• Branched out to a systems point of view.
• Double bind communication messages – Mixed messages.
• Marital skew – domination by one whilst the other accepts and children
believe its normal.
• Marital Schism – undermine spouse, threats of divorce, looks for loyalty
and affection of child.

5. CURRENT CONCEPTS
Combined into 8 view points
Object Relations Family Therapy
• Psychodynamic view
• Relationships with „objects‟
• Bring introjects into relationships
• Disturbs the family relations
• Gain insight

6. EXPERIENTIAL FAMILY THERAPY
Whitaker – Symbolic experiential family therapy
Brings symbols and fantasies so we can grow
Emotion focused couples therapy – change negative interactions
focusing on emotional connection
Transgenerational Family Therapy
• Each family member is tied in some way. Individual problems arise and
are maintained
• Marries someone similar and the trend continues
• Can result in schizophrenia

7. STRUCTURAL FAMILY THERAPY
• SALVADOR MINUCHIN
• RULES, ROLES, ALIGNMENTS, COALITIONS, BOUNDARIES, SUB
SYSTEMS.
• CHANGE PATTERNS TO UNFREEZE.
• STRATEGIC FAMILY THERAPY
• JAY HALEY – PARADOXICAL INTERVENTIONS
• SYSTEMIC FAMILY THERAPY – DIRTY GAMES AND POWER
STRUGGLES
• BOSCOLLO AND CECHING – CIRCULAR QUESTIONING

8. C.B.T
Cognitive Behavior Family Therapy
Behavior – Reinforcement
Cognitive – dysfunctional beliefs
Learned schemas
Social Constructionist Family Therapy
Challenge systems thinking
Limited lens
Reality is mediated through language and are socially determined through our
relationships
offer new alternatives

9. NARRATIVE THERAPY
Narrative Therapy
 Michael White – Reality is organized and maintained through our stories
 Negative stories are overwhelming
 Reduce power of problem stories
 Reclaim successful stories
 Life is multistoried
 New alternatives
 Externalization

11. Continuity
Predictable events
Change
Situational family
crises
 Transition points
THEORY OF PERSONALITY

12. FAMILY RULES
Established expectations
Persistent, repetiti
ve behaviors
Rules regulate and
stabilize family
system
Redundancy
principle: Family dysfunction

13. FAMILY NARRATIVES AND ASSUMPTIONS
Assumptions of self, family and the world
Meanings given to events/situations
Dominant stories/assumptions passed on from one generation to next

14. Pseudomutuality
Separateness vs.
Togetherness
Pseudohostility
Arguments/Bickering
between family
members
PSEUDOMUTUALITY AND PSEUDOHOSTILITY
FRAGMENTED AND IRRATIONAL COMMUNICATION (TO AVOID DEALING WITH
UNDERLYING ISSUES)

15. MYSTIFICATION
Masking the main problem
To distort one‟s experience by denying what he/she believes is happening
Contradicts one person‟s perception

16. SCAPEGOATING
Avoid dealing with main issue
Blaming an identified individual for everything that goes wrong
The identified person carries on the role.

17. ANASTASIA

19. WHO CAN WE HELP?
WHO CAN WE HELP?
INDIVIDUAL
PROBLEMS
INTERGENERATIONAL
PROBLEMS
MARITAL PROBLEMS

20. INDIVIDUAL PROBLEMS
WORKING WITH
SINGLE
INDIVIDUALS
LOOK FOR
CONTEXT OF
BEHAVIOR
WHEN
PLANNING AND
EXECUTING
INTERVENTIONS

21. WHAT ARE INDIVIDUAL PROBLEMS?

22. INTERGENERATIONAL PROBLEMS
PARENT & CHILD
PARENT &
ADOLESCENT
CONFLICT WITH
PARENT OR
SOCIETY
OUTDATED
RULES AND
BOUNDRIES
INTERVENTION
STREINGTHEN
PARENTAL
SUBSYSTEM
DEFINE NEW
BOUNDRIES &
RULES

23. WHAT ARE INTERGENERATIONAL PROBLEMS?
DELEQUINCY AND AT RISK YOUTH
CHILDREN TO FOREIGN BORN PARENTS

24. MARITAL PROBLEMS
SYMPTAMATIC
BEHAVIOR
TRACE TO
EFFORTS BY THE
FAMILY TO DEAL
WITH CONFLICT
LOOK FOR
INTERPERSONAL
DIFFICULTIES
INTERVENTION
THROUGH
THERAPY

25. WHAT ARE MARITAL PROBLEMS
INEFFECTIVE COMMUNICATION PATTERNS
SEXUAL INCOMPATABILITIES
ANXIETY OVER MAKING/MAINTINIGN LONG TERM COMITMENT
CONFLICTS OVER:
• MONEY
• IN-LAWS
• CHILDREN
• PHYSICAL ABUSE
• POWER AND CONTROL

26. WHAT CAN WE DO?
LENGTH OF
TREATMENT
BRIEF OF EXTENDED
RELETIVLY SHORT TERM
(10-20) SESSIONS
SETTINGS AND
PRACTITIONERS
OUTPATIENT OR INPATIENT
SCHOOLS
HOSPITALS
PSYCHIATRISTS
PSYCHOLOGISTS
MFT’S
SOCIAL WORKERS
PASTORAL COUNCELORS
STAGES OF
TREATMENT
BEGINNING –
CONTACT, HISTORY AND
RAPPORT
MIDDLE – REDEFINE THE
PRESENTING PROBLEM
END – LEARN COPING
SKILLS ANDPROBLEM
SOLVING TECQNIQUES

27. EVIDENCE
INSURANCE
COMPANIES
NEED
EVICENCE!
INCREASED
FUNDING FOR
F.T. RESEARCH
WHICH
METHODS
WORK?

28. WHICH METHODS WORK?

30. BACKGROUND: FRANK AND MICHELLE
F R A N K
Fathered two children: Ann
(13) and Lance (12.
Widower – Lost wife to cancer.
Children spent a lot of time
alone, Ann took over parenting
role for her brother Lance.
M I C H E L L E
Mothered one daughter, Jessica
(16).
Divorced husband b/c of
substance abuse, verbal
abuse, and lack of employment.
Michelle and Jessica developed
a very close mother-daughter
relationship for 12 years.

31. GENOGRAM

32. PROBLEM
Frank: feeling guilt
about not being an
adequate provider for
the family, troubled
with little earnings and
medical bills.
Michelle: experiencing
jealousy due to Frank‟s
frequent business
trips, feeling
unattractive and fearful
of abandonment by
Frank. Ironically, her
focus on Frank caused
her to abandon Jessica
for the first time.
Jessica: losing
closeness to her
mother made her very
resentful towards the
entire family, sought
comfort and belonging
from a school gang and
became a “tagger”.
Ann: feels that Michelle
is unable to fill the
responsibility of
mothering her and her
brother. Shows no
respect towards
Michelle, very bossy.
Lance: unable to
properly grieve over
the loss of his mother
and stressed by familial
conflict, he began
wetting his bed.
INCREASED TENSION BETWEEN THEIR
CHILDREN
MOSTLY INDIVIDUAL ISSUES THAT WERE
TRIGGERED BY THE STRESS OF BECOMING
A N “ I N S T A N T F A M I L Y ”

33. TREATMENT
Provide therapy sessions specific to each major subsystem. Good for strengthening
bonds where closeness had been severed.
 Frank and Michelle: child-rearing, romantic getaway, alternative income.
 Jessica, Ann, and Lance: build sibling relationship, give privacy to parents.
 Frank, Jessica, and Lance: grieving the loss of their mother.
 Michelle and Jessica: rebuild mother-daughter relationship, discuss Jessica’s school
issues.
 Frank and Lance: develop father-son bond, help Lance eliminate bedwetting through
behavioral program.
 Ann: Make her feel special, discuss talents, hobbies, friendships and allow her to be
the child.
Discuss boundary issues with entire family.

34. FOLLOW-UP
S T R U C T U R A L C H A N G E
Moving forward they were able to
quickly recognize the dyad or
triad that caused dysfunctional
patterns and get themselves
back on track.
The family became
more integrated
and better
functioning.
Ann, Lance, Michelle
and Jessica feel
much closer to one
another.
B E H A V I O R A L C H A N G E
Frank became proactive at
work, received a promotion
and bought the family a
larger home.
Lance stopped wetting his
bed.
Ann invested her interest in
school clubs and allowed
her self to “be a kid”.
Jessica broke away from
the school gang and began
focusing on attending a
local college.