Family therapy concepts

Family Therapy Concepts 1
By Chris Lobsinger
2013

Family Therapy Concepts 1
• This four hour workshop is meet to
introduce to participants some of the basic
ideas and components that are associated
with a body of knowledge referred to as
Family therapy
• In order to present a more congruently it
will be following the Leeds Systemic Family
Therapy Model as laid out in the Leeds
Systemic c Family Therapy Manual, Ms
Helen Pote et al 2000

Basic concepts of System
theory
• In the world of systems therapy, linear
causality does not exist. Instead we find
an emphasis on reciprocity, recursion,
and shared responsibility
• A and B exist in the context of a
relationship in which each influences
the other and both are equally cause
and effect of each other behaviour

Basic concepts of System
theory
• Over time, A and b establish patterns
characteristic of their particular relationship
• Our perspective is holistic, and our focus is on
the process, or context, that gives meaning to
events instead of only on the individual or the
events in isolation. Our focus is also present
centred, we examine here-and now interactions
rather than look to history for antecedents
causes.” (Leeds Systemic c Family Therapy
Manual, Ms Helen Pote et al 2000)

Models of Family Therapy
1. What is marriage and family therapy?
• Marriage and family therapists practice a unique
profession. Family therapy began as a breakaway
movement from psychiatry in the 1950's
• Marriage and family therapists may see individuals,
couples, families, and/or groups, yet they retain their
interactional perspective regardless of the configuration
of clients
• Marriage and family therapists take an interactional
perspective, and build on client strengths, rather than
assumed pathology

What is the philosophy of
family therapy?
• Each family operates on the basis of predictable
patterns of interactions
• patterns of behaviour being passed and
replicated from generation to generation
• Family members are always affected by one
another's issues. 91): “
• (Distant Education for Family Therapy
Counselling and Supervising
-http://www.dmrtk.jgytf.u-
szeged.hu/phare/eng/main.htm)

Some classifications of family
therapy• Behavioural Family Therapy
• Bowen theory
• Brief Therapy: MRI
• Contextual Therapy
• Eriscksonian Family Therapy
• Focal Family Therapy
• Milan Systemic Therapy
• Family Psychoeducational Therapy
• Strategic Therapy
• Structural Therapy

Types of Family Therapy
• Structural Family Therapy (Minuchin, 1974,
Colapinto, 1991)
• Conjoint Family Therapy (Satir, 1967)
• Contextual Therapy (Boszormenyi-Nagy,
1991)
• Strategic Therapy (Madanes, 1981)
• Brief Therapy
• Milan Systemic Therapy (Boscolo et al,
1987)
• Narrative Therapy (Freedman, Combs,
1996)

• “It is important to note that Family therapy is
probably a misnomer. When family therapy is
built on the assumption of systems theory,
amore appropriate label would probably be
relationship therapy.”
• Family Therapy a systemic integration 3rd
edition Dorthy Becvar and Raphael Becvar, 1988
p12
• *Another alternative is the term systemic
therapy

Contrasting individual and
family Therapy
• Individual therapy Family Therapy
• Asks why Asks what
• Linear Cause and effect Reciprocal causality
• Subjective/objective Dualism Holistic
• Either/or Dichotomies Dialectical
• Value-free Science Subjective/Perceptual
• Deterministic/Reactive Freedom of
Choice/Proactive
• Laws & Law like External reality Patterns
• Historical Focus Here-and now focus
• Individualistic Relational
• Reductionistic Contextual
• Absolutistic Relativistic

CyberneticEpistemology/Systems
Epistemology
• Metaphors of pattern Metaphors
of Material
• Cybernetics Physics
• Mind Body
• Communication Energy
• Biological World Physical
• Organization of whole Ingredients
of whole
• Qualitative analysis Quantitative
Analysis
• Mechanistic Explanation Vitalistic
Explanation

Systems Focus
• In working systemically the central focus
should be upon the system rather than the
individual
• The system may usefully be thought of as
the household or a wider family system,
and may include friends, people in
institutions (school, work, church)
• A consistent view is that these difficulties
do not arise within individuals but in the
relationships, interactions and language
that develop between individuals

Systems Focus
• Rock and dog
• Definition of a system
• Environment-systems-subsystems
• Open and closed system
• Wholeness
• Boundary
The interface between the system and its
environment is called the boundary of the
system

Boundary
The interface between the system and its
environment is called the boundary of the system

Circularity
• Patterns of behaviour develop within systems, which are
repetitive and circular in nature and also constantly
evolving. Behaviour and beliefs that are perceived as
difficulties will also therefore develop in a circular
fashion

Punctuation
“Disagreement about how to punctuate the
sequence of events is at the root of countless
relationship struggles

Connections and Patterns
• In understanding relationships and difficulties
within systems it will be important for the
therapist to consider the connections between
circular patterns of behaviour
• The process of therapy should enable family
members to consider these connections from
new and/or different perspectives
• All communication provides direct access to
world views and world views reflect processed
structure.

Connections and Patterns
• Structure is like a snap shot of process
• Process is like making a movie basic on the
structure
• Structure and process seen as communication
reflect world view

Symmetrical and
complementary interaction
• Symmetrical interaction is characterised by
equality and the minimization of difference
• complementary interaction is based on the
maximization of difference
• Rigid symmetrical or complementary patterns
may be problematic
• Meta- complementary – A lets or forces B to be
in charge
• Pseudo-symmetry – A lets or forces B to be
symmetrical
• Triangulation

Narratives and Language
• Behaviours and beliefs form the basis of stories
or narratives
• The language that is used to describe these
narratives and the interactions between
individuals constructs the reality of their
everyday lives
• At times when stories lived and stories told are
incongruous change

Constructivism
• This is the idea that people form autonomous
meaning systems and will interpret and make
sense of information from this frame of
reference
• People cannot make assumptions about what
meaning will be attributed to the information
they offer/contribute to others
• Thus there is only the possibility of perturbing
other people’s meaning systems

Reality
• Direct experience of reality (naïve reality) what you see
is what you get.

Constructivism
• No direct experience of reality (constructivism) The map
is not the territory

Social constructivism
•Social constructivism - elephant and the blind men

Social Constructionism
• Relevant is the idea that meaning is created in
the social interactions that take place
between people and is thus context dependent
and constantly changing
• this takes precedence over the concept of a
single external reality

Cultural Context
• The therapist should consider the importance
of context, in relation to the cultural meanings
and narratives
• The relationship between these narratives, the
therapeutic relationship and its context
• The family should be an important
consideration at the point of referral and
throughout the therapy

Power
• The therapist should take a reflexive stance in
relation to the power differentials that exist within
the therapeutic relationship, and within the family
relationships
• No powerlessness
• No Power in a (Batesonian sense)
• Victim in oppressor, oppressor in victim

Co-constructed therapy
• In therapeutic interactions reality is co-
constructed between the therapist (and
team) and the people with whom they
meet
• They form part of the same system, and
share responsibility for change and the
process of therapy
• Particular attention should thus be paid to
the contributions that all members of the
therapeutic system make in the process of
change

Self-reflexivity
• The therapist should aim to apply systemic
thinking to themselves and thus reject any
thinking about families and their processes that
does not also apply to therapists and therapy
• Self-reflexivity focuses especially on the effect
of the therapy process on the therapist
• In order to use self-reflexivity it will be
necessary for the therapist to be alert to their
own constructions, functioning and prejudices so
that they can use their self effectively with the
family

Strengths and solutions• The therapist should take a non-pathologising, positive
view of the family system
• A family system that enters the therapeutic system
should be considered as a system that owns a wealth of
strengths and solutions in the face of difficult situations
• It is important for the therapist to recognise that there
is a multi-versa of possibilities available for each family
in the process of change
• The therapist can facilitate this process by attending to
the strengths and solutions in the stories that the family
system brings to therapy

Models of therapeutic changeFeed back - System
• In a system where a transformation occurs, there
are inputs and outputs. The inputs are the result
of the environment influence on the system, and
the outputs are the influence of the system on
the environment. Input and output are separated
by duration of time, as in before and after. Or
past and present

Feed back loop
• In every feedback loop, as the name suggests,
information about the result of the transformation or an
action is sent back to the input of the system in the
form of input data
• If these new data facilitate and accelerate the
transformation in the same direction as the proceeding
results, they are positive feedback
• If the new data produce a result in the opposite
direction to previous results, they are negative feedback

“An appropriate Fiction for
behavioural Science”
• Some one needs to provide a fiction for the
behavioural sciences that would work like the
elegant fiction upon which physics was built-its
Newtonian Particle. The idea of a recursive
network with feedback structure provides a
useful fiction behavioural science. (The
Aesthetics of change Bradford Keeny the
Guildford press New York London 1983)

Positive and negative feedback
• Positive feedback leads to divergent behaviour

Positive and negative feedback
• positive feedback loop left to itself can lead
only to the destruction of the system, through
explosion or through the blocking of all its
functions
• Negative feedback leads to adaptive, or goal-
seeking behaviour: sustaining the same level,
temperature, concentration, speed, direction

• In a negative loop every variation toward a plus
triggers a correction toward the minus, and vice
versa. There is tight control; the system
oscillates around an ideal equilibrium that it
never attains. A thermostat or a water tank
equipped with a float are simple examples of
regulation by negative feedback

Deviation amplifying feed back
(positive feed back)
• If the family system is to function effectively; it
must be able to encourage desirable changes in
behaviour and to adapt to changes in the family
members as they grow older. The positive feed
back loop provides the necessary mechanism
• Difference that makes a difference
• News of difference
• Sameness and difference - stability and change

Prescribed practices as in line
with the Leeds model
• The prescribed practices described below are things that
would not be included in a routine therapy session. It
may be that on one or two occasions it is appropriate to
use one of these approaches; however they must be
used within a systemic framework that is, using the
guiding principles outlined at the start of this manual

Advice
• As a systemic therapist you would not
usually offer direct advice to the family
about their interactions or the difficulties
they are experiencing
• advice may be appropriate in helping the
family work towards their goals, advice
may be offered in a non-directive or
reflexive manner. Options should be
presented as choices about which the
family can make their own decisions

Interpretation
• Psychodynamic interpretations about the
meaning of symptoms or interactions in
relation to individual or trauma would not be
usual for systemic therapists
• Rather, meanings are explored in relational
and interactional terms between members of
the system

Un-transparent/closed practice
• Therapists should not remain closed about their
working practices, ways of thinking and
understanding the difficulties
• They should try to remain transparent by
explaining their practices at the beginning of
therapy, and during therapy as appropriate

Therapist monologues
• In the co-created process of therapy therapists
should not find themselves lecturing or using
long monologues in their interactions with the
family
• The process should be more like a sharing of
ideas between therapist and family, and
between family members

Consistently siding with one
person
• In taking a neutral stance therapists should not find
themselves consistently siding with one person in the
family
Working in the transference
• Therapists should be paying attention to the relational
and engagement issues between themselves and the
family with which they are working but they should not
use the relational aspects between themselves and the
family

Inattention to use of language
• Therapists should not be inattentive to
the use of language used by the family
• They should pay attention to the both
the words and phrases used, and the
meanings attributed to these

Reflections
• Therapist’s simple reflections of the points or phrases
that are used by the family should be kept to a
minimum. Reflections may be used to enhance
engagement and to develop the family’s sense of being
listened to and understood, but when used, reflections
should be followed by questions, and increased curiosity
about the issues presented

Polarised position
• Therapists should avoid taking a position which is
polarised from that of the family, or a position which is
likely to escalate to a polarised position
• The therapeutic team can enable the therapist to
achieve this by presenting the multiple perspectives
from which the family situation can be understood
Sticking in one time frame
• Therapists should not stick in one time frame, but move
the focus of their questions and discussion between the
past, present and future

Agreeing/not challenging ideas
• Therapists should not be in a continual state of
agreement with the family’s ideas
• They should remain curious and challenging
about the nature and content of these ideas,
in order to introduce new unexplored
possibilities and ideas

Ignoring information that
contradicts hypothesis
• Therapists should not ignore, or minimise
information presented by the family which
contradicts their own ideas and hypotheses
Dismissing ideas
• The ideas presented by the family about the
difficulties with which they are struggling, or
the process of therapy itself should not be
dismissed by the therapist

Inappropriate affect
• The therapist’s affect should match that of
the family, and would be considered
inappropriate if it remained dissimilar from
family for an extended period of time
• One example might be if the family were
feeling optimistic about change and the
progress they were making, and the
therapist remained pessimistic

Ignoring family affect
• Therapists should pay attention to the affect that
the family is showing in the session, and not ignore
strong expressions of affect during the sessions
• This may be particularly relevant when a member
of the family shows distress during the meeting,
either by sad or angry behaviour
Ignoring difference
• Therapists should not ignore issues of difference
between themselves and the family or within the
family

Family Therapy concepts Part II
Chris Lobsinger 2013

Plan of development
• Assessment
• Overview of specific goals
• Pre-therapy
• Initial sessions
• Middle-sessions
• End- sessions

Assessment Performa family
• Demographic Information
• Genogram / Ecogram /timeline
• Migration and trauma history
• Referral information
• Needs assessment
• Family Structure/process
• Change
• Cultural formulation

6. Family Structure/Process
• The way in which activities within the home are organized
along gender, generational lines and roles
• The connections which partners maintain with their network of
friends and relatives
• Partners attitudes towards their children
• The way in which the family members perceive the connection
between the individual and the world (e.g. Autonomy of the
individual or the individual in relation to family and
generations/ in relation to culture - dominant/non-dominant)
• Coalitions, alliances, boundaries, hierarchy within the nuclear
and extended families)
• Communication and behavior patterns
• Role and relationships clarity
• Strengths (eg., coping mechanisms)

Convening Sessions
In deciding whom to invite to the firsts session
• Who is living in the household?
• Who else is mentioned as important members of the family
system?
• Recent family life events, that may affect attendance e.g.
childbirth / separation.
• Is further information required from referrers before
therapy can commence?

Convening Sessions
• What professional systems are involved with
the family? In relation to:
• i. The presenting issues.
• ii. Other issues, such as child protection.
• Would it be helpful to initiate a professional
/ network meeting prior to the therapy
commencing?

Before the initial session
discuss the therapy.
• Team working
• Attendance issues, who will be coming, how
to get there, and
• ambivalence about attending.
• Therapist’s interest in hearing everyone’s
ideas
• Confidentiality

Pre-therapy preparation
• Construct a genogram and ecogram from
referral information
• Summarize the main themes from the
referral
• Consider the recent life events of the family
• Consider difficulties which may arise around
engagement and how to address these

Pre-therapy preparation
• Consider broader system issues, and define
who is in the network
• Brainstorm
themes/hypotheses/formulations which
may be relevant to the family

Genograms
• All members of the family system, including
adopted/fostered members
• Delineation of the household
• All members of the wider system
• Dates of birth
• Deaths, with dates

Genograms
• Partnerships and marriages, with dates
• Separations and divorces, with dates
• Pregnancies, miscarriages, and
terminations, with dates
• Occupations / Schooling
• Any information that is missing from the
referral information should be noted and
enquired about during the initial session of
therapy.

The Ecomap
• 1) includes the major systems that are a part
of the family's life;
• 1) includes the major systems that are a part
of the family's life;
• 3) portrays an overview of the family in their
situation by, picturing the important nurturant
or conflict connections between the family
and their world;

The Ecomap
• 4) demonstrates the flow of resources or the
lack and deprivations;
• 5) highlights the nature of the interfaces and
indicates conflict for mediation and resources
to be identified and mobilized.

Goals during initial session
• Outline Therapy Boundaries & Structure
• Engage and Involve all family members
• Gather and Clarify Information
• Establish Goals and Objectives of Therapy

Goals during middle sessions
• Develop and Monitor Engagement
• Gather Information and Focus Discussion
• Identify & Explore Beliefs
• Work towards change at the level of beliefs
and behaviors
• Return to Objectives and Goals of Therapy

Goals during ending sessions• 1.Gather Information and Focus Discussion
• 2. Continue to work towards change at the
level of behaviors and beliefs
• 3. Develop family understanding about behaviors and beliefs
• 4. Secure Collaborative Decision re: Ending
• 5. Review the process of therapy

Pre-therapy preparation• Construct a genogram from referral
information
• Summarise the main themes from the referral
• Consider the recent life events of the family
• Consider difficulties which may arise around
engagement and how to address these
• Consider broader system issues, and define
who is in the network
• Brainstorm themes/hypotheses/formulations
which may be relevant to the family

Pre & Post Session Preparation
• Summary of the main themes from previous session
• Information which requires clarification from previous session
• Between session contact the therapist has had with the
family/wider system
• The current formulation/themes/hypothesis of the issues with
which the family are bringing
• Ways forward for the current session which are being
considered
• Any team – therapist issues which need to be addressed
• Any family – family/team issues which need to be addressed
• CONSIDER THE 6. FAMILY STRUCTURE/PROCESS

Outline Therapy Boundaries &
Structure
• Introductions
The therapist should introduce himself or
herself as a team member and explain the
role and context within which they work
(the team and the centre).
• Team working
The therapist should explain that they work
as part of a team, and that the team’s role
is to generate ideas and help the therapist
understand the family / system.

• The confidentiality of any information discussed in
the session should be outlined. Specific statements
about the boundaries of confidentiality should be
made in relation to other systems.
• Structure of the session Information should be given
on the length of the meeting, the breaks, and the use
of team feedback through messages or reflecting
teams. Explain that during the break,
Confidentiality

• Structure of therapy Explain that if the family/team
decide to meet again, that the meetings will be
decided together by the family / team in accordance
with their needs and wishes.
• Questions Time should then be spent giving the
family an opportunity to ask questions and meet the
team. Agreement to proceed with videoing should be
confirmed, and the family informed that the video
will now be switched on.

Engage and Involve all family
members
•Supportive environment Initially it is
very important for the therapist to
provide a warm, supportive and empathic
environment, to increase trust and
rapport and to build the therapeutic
relationship

• Hear from everyone: Therapists should try to hear from
all members of the system/family, initially connecting
with them all at an individual level, and assessing the
level of contribution they feel they are able to make to
the discussion
• Neutrality: The therapist is trying not only to hear
everyone’s views but also to establish their interest in
different perspectives that may be held within the
system.

Gather and Clarify Information
• The concept of therapy
• The system
• The presenting difficulties or issues
• Solutions and successes to date
Attention should be paid to collecting
information in a circular manner. Although it
will be appropriate to ask linear questions in
collecting information, especially at this early
stage of therapy, circularity can be maintained
by linking multiple linear questions between
family members in a circular way.

Establish Goals and Objectives
of Therapy
• The therapist should consider with the system
what are their goals and objectives for therapy
• The establishment of goals should be achieved
in a way which expresses the Possibility of
Change, and should convey the expectation
that change is possible, and likely to occur

Post-session
• Review of main interventions and family’s
response
• Ideas for future sessions, themes/issues to follow
up,
• E.g. narrative prompts, unexplored areas, facts
to check
• Feedback to therapist of team observations
• Therapist’s reflections on issues evoked for them
by the session
• Review of important information shared, e.g. life
events, elements of genogram
• CONSIDER THE 6. FAMILY STRUCTURE/PROCESS

Case notes
• All written records should be non-pejorative, legible,
dated, signed, with no abbreviations. Alterations and
Corrections should be clearly marked and signed. Case
notes should include:
• Family information sheet & Genogram/ecogram-
ecomap
• Referral information/letter
• All other written communications to and from the
centre
• Record of attendance
• Sessions notes
• Notes on telephone contacts to and from the centre

Session notes
Session notes should include :
• Date and number of session
• Who attended therapy
• Therapist/Team member names
• Main themes of the session – including key
language used by family
• Team observations – clearly labelled as
impressions
• Record of interventions
• Key points/ideas/decisions to follow up in
later sessions

Middle sessions
Basic Structure for a session
• Pre-session
• Session
• Message
• End session
• Post session

Goals during middle sessions
• beliefs and behaviors Develop and Monitor
Engagement
• Identify & Explore Beliefs
• Work towards change at the level of
• Return to Objectives and Goals of Therapy

Develop engagement
• The therapist should pay particular attention to
developing a co-constructed therapeutic
relationship. In addition to attending to the three
aspects of engagement from the initial meeting
(supportive environment/hearing from
everyone/neutrality), attention should be paid to:
• Creating and offering choices about the process of
therapy
• Resolving issues in the family-therapist-team system
as they arise. This will require therapists to allow
sufficient time for team discussions pre and post
sessions and time within sessions to discuss the
process of therapy with families and any concerns
or questions they have in relation to this.

Gather information & focus
discussion
The therapist plays a role in developing this discussion to
develop themes and keep the discussion focused.
Information may often focus on the following topics:
• The presenting difficulties or issues: Therapists’
should be collecting this information in a manner that
enables circular descriptions of behavior to develop
• The family and wider system: The therapist will still
gather information about the family and wider system
as is necessary to understand the information and
stories being presented by the family
• Solutions & Successes: The focus on the successes
and solutions available to the family should be
steadily increasing throughout therapy

Identify & explore beliefs
• The therapist should identify and explore the
family’s thoughts, beliefs, myths or attitudes,
which may be contributing to their dilemmas
and difficulties
• Circular questions which build up circular
descriptions of behavior can also be used to
explore the beliefs and assumptions which lie
behind those behaviors

Therapists should explore the family’s beliefs in relation to:
The presenting difficulties.
• E.g. What ideas has your wife come up with to explain the
behavior John is showing?
Relationships within the family and with the wider system.
• E.g. Who feels it is most important to keep liaising with the
school over this issue?
Solutions that have been tried or hypothesized
• E.g. What gave you the confidence to keep going with this
new idea?

Successes in all areas of family life and relationships to
the wider system
• E.g. Would that be judged as a success in your family?
Therapy process, beliefs about therapy
• E.g. What led to your decision not to bring the
children to today’s meeting?
Family behavior during therapy
• E.g. Jill is looking distressed, what do you think was
so upsetting for her in talking about the difficulties
you are experiencing?

Work towards change at the
level of beliefs and behaviours
Challenge existing patterns and assumptions:
• To move with the family to a position where they
are able to query their own beliefs, perceptions and
feelings
• Th: How would your Nan explain the times when
you and your mum do get on well together?
• John: Well she says we are alright when we stop
and listen, sometimes we can just bite off each
other’s heads you see, over nothing, when no-one
has really done anything wrong

Work towards change at the
level of beliefs and behaviours
Provide distance between the family and the problem:
• Providing distance to try and free the family from the pressure
of the difficulties, so that they are more able to consider and
reflect upon them. Alternative perspective circular questions
and those aimed at looking at possible futures can often be
helpful in achieving this
Externalize
• That is to give the problem an external, objective reality
outside of the person. This can be useful in mobilizing the
family’s resources to unite in working towards solutions and new
ways of thinking which challenge the difficulties.
• Externalization means to put something outside of its original
borders, especially to put a human function outside of the
human body. The opposite of externalization is internalization

Reframing – Virginia Satir
• Reframing is altering the meaning or value
of something, by altering its context or
description
• Reframing is a powerful change stratagem.
It changes our perceptions, and this may
then affect our actions. But does changing
our symbolic representation of the real
world actually change anything in the real
world itself?

Reframing – Virginia Satir
• A classic example of a reframe by Virginia Satir
concerns a father who complains at the
stubbornness of his daughter.
• There are situations where she will need
stubbornness, to protect herself or achieve
something. Reframing switches to a context that
makes the stubbornness relevant.
• It is from the father himself that she has learned
to be stubborn. By forcing the father to equate
his own stubbornness with hers, this creates a
context in which he either has to recognize the
value of her stubbornness, or deny the value of
his own

Open up new
stories/explanations
Either by facilitating the family’s evolution of new ideas
and narratives, or by the introduction of these ideas
by the therapist. All family members will have
stories about their lives, the lives of other family
members, and the life of the family. Exploration of
neglected information may open up the development
of stories which are more helpful to the family in
coping with their concerns. Information which is
neglected often concerns:
• Successes
• Solutions
• Exceptions
• Alternative views from the network
• Other strengths

Elicit solutions
• It will be helpful to gather information from
the family about solutions for the difficulties
that they have tried or would consider useful
• Ideas generated by them are usually most
helpful and linear questions are often used to
develop an overview of solutions that the
family have tried or thought of

• Amplify change: In order to maximize the
change or potential change that is occurring
throughout the course of therapy it will be
important for the therapist to focus on
statements the family present about progress
• Enhance mastery: To encourage the family to
gain a sense of mastery or control over their
situation, their thoughts, feelings and
behaviors. This should enable the family
members to take responsibility for their own
roles and actions, and for the process of
change

Introduce therapist/team ideas
• May include the therapist sharing their ideas
and hypothesis about the family, individual,
or difficulties, for a variety of reasons.
Including:
• Normalize difficulties
• Move the family to new ideas
• Connect family’s ideas
• Suggest ways to organize the discussion,
e.g. Enactments

Linear questioning
• Direct linear questions can often be useful in
gathering information from the system and
clarifying information given, especially at the
beginning of therapy
Circular Questions
Circular questions are aimed at looking at
difference and therefore are a way of
introducing new information into the system.
They are effective at illuminating the
interconnectedness of the family sub-systems
and ideas

Statements
Statements are used by the therapist for 3 main
functions:
• To clarify and acknowledge a communication from
the family
• To comment on the position or emotional state of a
member of the family
• To introduce therapist/team ideas, directly or in
the form of a reflecting team.
• In using statements therapists should ensure that
they are not of long duration, and do not become
therapist monologues

Positive connotation
• From the Milan systemic group, a complex paradoxical
reframing technique which includes all family members
and the system itself
• Each family member's contribution to the problem is
reframed as an effort to solve problems and help meet
the family's needs

Metaphor
• A figure of speech in which a word or phrase that
ordinarily designates one thing is used to designate
another, thus making an implicit comparison, as in “a
sea of troubles” or “All the world's a stage”
(Shakespeare)

Narrative description
• Utilizing the interactional dynamics of family
therapy, people can deconstruct oppressive
and debilitating perspectives, replace them
with liberating and legitimizing stories, and
develop a framework of meaning and direction

THE MIRACLE QUESTION Steve
De Shazer
• "If you go to bed tonight and when you awake in
the morning a miracle has occurred overnight and
everything is going well in your marriage, then how
would you know (or indeed how would any on else
know, like a relative or a friend?......Note: because
your are asleep you won't know that there has
been a miracle) ...what will be different?...What
will you see? What will you be hearing, doing,
feeling? What are you going to notice if the
problem is no longer there, what is it that is
different about the situation that demonstrates to
you that the problems has been replaced by
solutions?....what else?....

Tasks
• Noticing tasks
• Between now and next time we meet, we would like you to observe
, so that you can describe to us next time what happens in your
family that you want to continue to have happen (De Shazer and
Molnar 1984)
• Writing tasks
• Counting tasks
• Using a piece of string, count the ( to tie knots in) number of time
that you compliment someone in your family between now and the
next time we meet.
• Playing tasks
• Hugs without warning
• E.G. Given to each participate secretly the job to give a family
member a hug without warning.
• Turn taking tasks
• E.G. Planning a family activity

• Naming the dilemma
• Change pattern
• Proscribe problem
• Counter paradoxes:
• Therapeutic double binds.
• For example the family was warned against
• premature change. The family feels more
acceptable and un-blamed for how
• they are while at the same time challenged to
change.
• The belief is that you can’t give a direct
prescription

Return to objectives and goals
of Therapy
The therapist should return to the issues of goals for
therapy as therapy progresses:
• If goals seemed unclear during the initial stages
of therapy, it may take some time and thought
with the family for them to consider the areas
they want to change in therapy, or to find
priorities for change.
• If goals are achieved, so that goals can be
renegotiated, perhaps for change at a wider
system level, or a decision to move towards
the end of therapy is made
• If goals change due to changing circumstances
for the family

Goals during end sessions
• Continue to work towards change at the level
of behaviors and beliefs
• Develop family understanding about behaviors
and beliefs
• Secure Collaborative Decision re: Ending
• Review the process of therapy

Gather information & focus
discussion
• The Presenting difficulties or issues
• Solutions and Successes to date
• The System / Wider system

Continue to work towards change at
the level of behaviour and beliefs
It is more common in end sessions for the focus to be on
the following methods:
• Amplifying change: In order to maximize the change or
potential change that is occurring throughout the course
of therapy it will be important for the therapist to focus
on statements the family present about progress
• Enhancing mastery: To encourage the family to gain a
sense of mastery or control over their situation, their
thoughts, feelings and behaviors
• Challenging existing patterns and assumptions: To
move with the family to a position where they are able
to query their own beliefs, perceptions and feelings
• Reframing: Reframe some of the constraining ideas
presented by the family. Relabelling in a positive way,
ideas and descriptions given by family members, in a
manner which is consistent with their realities

Developing new stories and
explanations
• Successes & Solutions
• Strengths
• Exceptions
• Alternative views from the network

Develop family understanding
about behaviours and beliefs
As therapy ends it will be important for the
therapist to work with the family to develop
and encourage their understanding of the
process of the development of difficulties.
Underlying family interactional patterns.
• Motivations for assumptions, behaviors and
feelings.
• Understanding of a family member’s reactions
to other’s behaviors

Collaborative ending decision
The timing of ending is not always obvious and in aiming to make
the ending process a collaborative process the therapist and
therapy team should be alert to a number of signals in sessions:
• Positive feedback from the family: the family situation or the
issues they presented are reported as improved or improving
• Negative feedback from the therapy: The family report
dissatisfaction about the therapy, or the progress they are making
• Therapist notices changes: Missed sessions by the family.
Changes in the level of engagement in therapy. Therapist notices
positive changes in the way the family are interacting during
sessions

The team should consider the following issues and then
gather the family’s views on these:
• Whether the family might feel it was appropriate to end
therapy, do they feel they have achieved what they set
out to achieve?
• How might the family prefer to end therapy, would they
like a follow up appointment or would they like to re-
contact the team if necessary?
• Might the family feel it would be important to engineer
systems of support, before therapy ends?
• With whom should the team share information about the
therapy and what has been achieved, e.g. referrer,
school.
• A useful and engaging way of saying goodbye to the
family

Once this information has been shared decisions should be
reached about:
• When therapy will end.
• What follow up arrangements will be made.
• What the family might do if difficulties should arise
again.
• Who will be contacted post therapy

Review the process of therapy
• It will be helpful for the therapist to invite the
family to review the process of therapy.
• What has been gained/lost for the family
through therapy?
• Any misunderstandings not addressed during
therapy should be clarified and addressed.
• Reasons for therapist’s behaviors and
procedures used.
• What might the family do differently if future
difficulties arise?

Family therapy concepts

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