Reflect on the most important things you learned from Accounting E.docx

Reflect on the most important things you learned from
Accounting Ethics class. What will you be able to take away
and apply from the class and in your portfolio project to both
your personal and professional life? Provide at least 3-5
examples of how this course has changed your perspective of
ethical standards.
Required:
Half to one page only with at least 2 references
Chapter 7: Intergenerational and Psychoanalytic Family
Therapies
“Bowen theory is really not about families per se, but about
life.”—Friedman, 1991, p. 134
1
Mastering Competencies in Family Therapy (2nd ed.)
Diane R. Gehart
©2014. Brooks/Cole, Cengage Learning. All rights reserved.
For classroom use only.
Lay of the Land
Intergenerational therapy and psychoanalytic family therapy
Share common roots:
Psychoanalytic theory and systemic theory
Draw from object relations theory and developed several unique
approaches:
Object relations family therapy, family-of-origin therapy and
contextual therapy
Share several key concepts and practices:
Examine client’s early relationships.
Tracing transgenerational family dynamics.

Promoting insight into extended family dynamics.
Identifying/altering destructive beliefs and behaviors learned
early in life.
Diane R. Gehart
Bowen Intergenerational Therapy
Diane R. Gehart
In a Nutshell: The Least You Need to Know
More about nature of being human than about families or family
therapy.
Broad perspective considering evolution of human species and
characteristics of all living systems.
Consider three-generational emotional process to understand
current symptoms.
Therapy involves increasing clients’ awareness of how current
behavior is connected to multigenerational processes.
Primary tool for client change is therapist’s personal level of
differentiation.
Diane R. Gehart
The Juice: Significant Contributions to the Field

Diane R. Gehart
Juice #1: Differentiation
Differentiation
Person’s ability to separate intrapersonal and interpersonal
distress.
Intrapersonal: Separate thoughts from feelings in order to
respond rather than react.
Interpersonal: Know where oneself ends and another begins
without loss of self.
Balance two forces: need for togetherness and the need for
autonomy.
Conceptualized on a continuum.
A lifelong journey; referred to as “maturity.”
Differentiated people better able to handle ups and downs of
increasing intimacy.
Level of differentiation expressed differently depending on
culture, gender, age, and personality.
Diane R. Gehart
Juice #2: Genograms
Genograms
Type of family tree or genealogy that specifically maps key
multigenerational processes that illuminate for both therapist
and client the emotional dynamics that contribute to the
reported symptoms.
Although originally developed for the intergenerational work in
Bowen’s approach, the genogram is so universally helpful that
many therapists from other schools adapt it for their approach,

creating solution-focused genograms.
Is simultaneously (a) an assessment instrument and (b) an
intervention, especially in the hands of an intergenerational
therapist.
Diane R. Gehart
Rumor Has It: the People and Their Stories
Diane R. Gehart
Significant Contributors
Murray Bowen
Georgetown Family Center:
Michael Kerr
The Center for Family Learning:
Philip Guerin
Thomas Fogarty
Monica McGoldrick
Betty Carter
David Schnarch
Diane R. Gehart

The Big Picture: overview of Treatment
Diane R. Gehart
Main Phases of Structural Therapy
How it works
Process-oriented therapy.
Relies on self-of-the-therapist: therapist’s level of
differentiation.
Does not emphasize techniques and interventions.
Use genograms/assessment to promote insight and intervene as
differentiated persons.
Use insight and therapeutic relationship to increase clients’
levels of differentiation.
Diane R. Gehart
Making connection: the therapeutic relationship
Diane R. Gehart
Differentiation and Emotional Being of the Therapist
Therapist differentiation
Level of differentiation and emotional being central to change

process.
Believe clients can only differentiate as much as therapist has
differentiated.
Therapist’s level of differentiation is focus of supervision early
in training.
Bowen therapists assert that theory cannot be learned through
books.
Diane R. Gehart
A Nonanxious Presence
What it is
Emotionally engaged stance that is nonreactive.
Therapist doesn’t react to attacks without careful reflection.
How it works
Greater level of differentiation; makes it easier to maintain
nonanxious presence.
Therapist doesn’t rush to rescue clients every time they feel
overwhelmed by strong emotion.
Therapist guides client through process of separating self from
other and thought from feeling.
Therapist’s calm center used to model differentiation.
Intergenerational therapist slowly coaches client through fears
to facilitate growth.
Diane R. Gehart
The viewing: case conceptualization and assessment

Diane R. Gehart
Emotional Systems
Humans part of evolutionary emotional process going back to
first cell with nucleus that was able to differentiate its functions
from other cells.
Family’s emotional process viewed as extension of cellular
differentiation process.
A family lacking differentiation may become emotionally fused;
an undifferentiated family “ego mass.”
Therapists focus on family’s unique emotional system not on
environment or culture.
System has significant impact on person’s behavior, emotions,
and symptoms.
Diane R. Gehart
Chronic Anxiety
What it is
Biological phenomenon that is present in all natural systems.
Automatic physical and emotional reactions not mediated
through conscious, logical processes.
Families exhibit chronic anxiety in response to crises, loss,
conflict, and difficulties.
Differentiation creates clearheadedness, allowing for reduction
in reactivity and anxiety.
Diane R. Gehart

The Multigenerational Transmission Process
What it is
Emotional processes from prior generations are present and
“alive” in current family emotional system.
Children may emerge with higher, equal, or lower levels of
differentiation than parents.
Severe emotional problems result from level of differentiation
becoming lower and lower with each generation.
Diane R. Gehart
Multigenerational Patterns
Assessing multigenerational patterns
Using genogram or oral interview, identify patterns of
depression, substance use, anger, conflict, or other salient
issues.
Identify how current situation fits with these patterns.
Is the client replicating or rebelling against the pattern?
How has the pattern evolved with this generation?
Diane R. Gehart
Level of Differentiation
Continuum of differentiation
Differentiation scale ranges from 1 to 100.
Bowen maintained people rarely reach higher than 70.
Note where and how person is able/unable to separate self from

other and thought from emotion.
Diane R. Gehart
Emotional Triangles
What they are
Triangle: Process in which a dyad draws in a third person to
stabilize it.
Important to assess because they are basic building block of
families.
Use third person to alleviate tension.
More you try to change relationship with third entity, the more
you reinforce aspects you want to change.
How they are used
Assess to identify primary relationship to be targeted for
change.
Everyone triangulates to some degree.
Pathological patterns emerge when this becomes primary means
for dealing with dyadic tension and dyad never actually resolves
the tension themselves.
Diane R. Gehart
The Family Projection Process
What it is
How parents “project” immaturity onto one or more children.
Causes decreased differentiation in subsequent generations.
Common pattern is for a mother to project her anxiety onto one
child, focusing all her attention on this child to soothe her
anxiety.

The child who is the focus of parent’s anxiety will be less
differentiated than those not involved in projection process.
Diane R. Gehart
Emotional Cut-Off
What it is
A person no longer emotionally engages with another in order to
manage anxiety.
Can take form of no longer seeing/speaking to other person.
Client believes cut-off is a sign of mental health/superiority.
Client reports cut-off helps manage emotional reactivity.
Higher levels of differentiation lessen need for cut-offs.
Sometimes more cut-off necessary because of extreme patterns
of verbal, emotional, or childhood abuse.
The more people can stay emotionally engaged without
harboring anger, resentment, or fear, the healthier they will be.
Diane R. Gehart
Sibling Position
What it is
An indicator of family’s level of differentiation.
More family members exhibit expected characteristics of sibling
position, the higher the level of differentiation.
How it works
Cultural background shapes the roles of sibling position.
Older children identify with responsibility and authority.
Later-born children identify with underdogs and question status

quo.
Youngest child most likely to avoid responsibility in favor of
freedom.
Diane R. Gehart
Societal Regression
What it is
Societies experiencing sustained chronic anxiety respond with
emotionally-based reactive decisions and regress to lower levels
of functioning.
Vicious cycle of increased problems and symptoms.
Cycles in which levels of differentiation rises and fall.
Diane R. Gehart
Targeting change: goal setting
Diane R. Gehart
Two Basic Goals
Increasing differentiation
General goal that should be operationally defined for each
client.
Decreasing emotional reactivity to chronic anxiety
As differentiation increases, anxiety decreases.

Helpful to separate goals to break process down.
Decreasing anxiety usually precedes increasing differentiation.
It is clinically helpful to tailor this to an individual client.
Diane R. Gehart
The doing: interventions
Diane R. Gehart
Theory Versus Technique
Integration of theory and technique
Primary “technique” is therapist’s ability to embody the theory.
Therapists understand theory and improve own differentiation.
Naturally promote clients’ level of differentiation through
interaction.
“Living” the theory is primary technique for facilitating change.
Diane R. Gehart
Process Questions
What they are
Process questions help clients see systemic process or dynamics
they are enacting.
Ex: Use process questions to help clients see how conflict they

are experiencing now is related to patterns they observed earlier
in life.
Diane R. Gehart
Encouraging Differentiation of Self
How it is done
Families tend toward togetherness and relationships for
survival.
Interventions encourage clients to use “I” positions to maintain
individual opinions/moods while in relationships.
Diane R. Gehart
Genograms
As an Intervention
Identifies problematic intergeneration patterns and alternative
ways for relating and handling problems.
Visual depiction of generational pattern inspires greater sense
of urgency and commitment to change.
Generates greater willingness to take action compared to
process questions and discussion of dynamics.
Diane R. Gehart
Detriangulation

What it is
Maintaining neutrality to interrupt client’s attempt to involve
therapist or someone else in a triangle.
Most therapists at some point will be “invited” to triangulate
against a third party.
How it works
Therapist “detriangulates” by refusing to take sides.
Therapist invites clients to validate themselves.
Examine own part in problem dynamic; take responsibility for
needs/wants.
Validation should not be approval as this undermines client’s
autonomy.
Clients coached to approve/disapprove own thoughts and
feelings and take action as needed.
Diane R. Gehart
Relational Experiments
What they are
Behavioral homework assignments designed to reveal/change
unproductive relational processes.
How they work
Interrupt triangulation by:
Increasing direct communication between a dyad.
Reversing dynamics fueled by lack of differentiation.
Diane R. Gehart

Going Home Again
What it is
A mature, balanced adult goes home to visit family and finds
themself acting like a teenager.
How it works
The result of unresolved issues in family-of-origin that can be
improved by increasing differentiation.
As level of differentiation grows, client can maintain clearer
sense of self in family system.
Client interacts with family members while maintaining a
clearer boundary between self and other.
Diane R. Gehart
Interventions for Special Populations
The Sexual Crucible Model
Marriage is a “crucible,” a vessel physically containing a
volatile transformational process.
Therapist achieves transformation by helping both partners
differentiate.
Partners take responsibility for individual needs rather than
demand other change to accommodate them.
Schnarch developed a comprehensive model for helping couples
create type of relationship most couples expect.
A harmonious balance of emotional, sexual, intellectual,
professional, financial, parenting, household, health, and social
partnerships.

Diane R. Gehart
Psychoanalytic Family Therapies
Diane R. Gehart
In a Nutshell: The Least You Need to Know
In the 1980s, renewed interest in object relations therapies led
to development of object relations family therapy.
Uses psychoanalytic and psychodynamic principles to describe
external relationships.
Family is a nexus of relationships that support or impede
development and functioning of members.
Therapy involves:
Analyzing intrapsychic and interpersonal dynamics.
Promoting client insight.
Working through insights to develop new ways of relating.
Diane R. Gehart
The Juice: Significant Contributions to the Field
Diane R. Gehart

Juice #1: Ethical Systems and Relational Ethics
What it is
An ethical system, keeps track of entitlement and indebtedness
within the family.
How it works
System maintains trustworthiness, fairness, and loyalty between
family members.
Its breakdown results in symptoms.
Goal of therapy is to re-establish ethical system.
Presenting complaint may be that things are no longer fair.
Diane R. Gehart
Rumor Has It: The People and Their Stories
Diane R. Gehart
Significant Contributors
Nathan Ackerman and the Ackerman Institute
Ivan Boszormenyi-Nagy
James Framo
David and Jill Scharff
The Women’s Project
Diane R. Gehart

The Big Picture: Overview of Treatment
Diane R. Gehart
Therapeutic Process
First task
Create caring therapeutic relationship, or holding environment.
Therapist analyzes intrapsychic and interpersonal dynamics that
are source of symptoms.
Second task
Promote client insight into dynamics; must get through client
defenses.
Therapist facilitates working through insights to translate them
into action in clients’ daily lives.
Diane R. Gehart
Making Connection: The Therapeutic Relationship
Diane R. Gehart
Transference and Countertransference
Transference

Client projects onto therapist attributes stemming from
unresolved issues with primary caregivers.
Use immediacy of these interactions to promote client insight.
Countertransference
Therapists project back onto clients, losing therapeutic
neutrality.
Used to help therapist and client better understand the reactions
client brings out in others.
Diane R. Gehart
Contextual and Centered Holding
Contextual holding
Therapist’s handling of therapy arrangements:
Conducting sessions competently.
Expressing concern for the family.
Being willing to see the entire family.
Centered holding
Connecting at deeper level by expressing empathetic
understanding to create safe emotional space.
Diane R. Gehart
Multidirected Partiality
What it is
Being “partial” with all members of the family.

How it works
Therapists accountable to everyone potentially affected by
interventions, including those not present in the room.
Therapist must bring out humanity of each family member, even
“monster member.”
Involves sequential siding by empathizing with each person’s
position in turn.
Diane R. Gehart
The Viewing: Case Conceptualization and Assessment
Diane R. Gehart
Interlocking Pathologies
What it is
Constant exchange of unconscious processes within families
creates interlocking or interdependent pathologies.
How it works
Individual pathology reflects family distortions and dynamics.
Therapist seeks to identify how identified patient’s symptoms
relate to less overt pathologies within the family.
Diane R. Gehart

Self-Object Relations Patterns
Self-object relations
How people relate to others based on expectations developed by
early experiences with primary attachment objects.
How it works
External objects are experienced as:
Ideal object: Primary caretaker desexualized/deaggressivized;
maintained as distinct from its rejecting and exciting elements.
Rejecting object: Representation of caregiver when child’s
needs for attachment were rejected, leading to anger.
Exciting object: Representation of caretaker formed when
child’s needs for attachment were overstimulated; longing for
an unattainable but tempting object.
Diane R. Gehart
Splitting
How it works
Frustration with primary caregiver increases need to spilt
objects.
Separate good from bad objects by repressing the
rejecting/exciting objects.
Leaves less of ego, or conscious self, to relate freely.
If splitting not resolved, there’s “all good” or “all bad” quality
to evaluating relationships.
In families, splitting can take the form of perfect vs. problem
child.
Diane R. Gehart

Projective Identification
How it works
In relationships, clients defend against anxiety by projecting
unwanted parts of themselves onto partner.
Partner is manipulated to act according to projections.
Ex: A husband projects interest in other women onto his wife as
jealousy and accusations of infidelity. The wife decides to hide
innocent information that may feed husband’s fear. The more
she tries to calm his fears by hiding information, the more
suspicious and jealous he becomes.
Diane R. Gehart
Repression
How it works
Children repress anxiety when they experience separation from
attachment object.
Less ego available for contact with outside world.
Until repressed material made conscious, adult replicates these
relationships.
One of primary aims is to bring repressed material to surface.
Diane R. Gehart
Parental Interjects

What they are
The internalized negative aspects of parents.
How they work
Parental attributes internalized and unconsciously projected
onto future intimate relationships.
Hear a parent’s critical comments in neutral comments of
partner.
Clients become conscious of introjects to increase autonomy.
Diane R. Gehart
Transference Between Family Members
What it is
Involves one family member projecting introjects and repressed
material onto others.
How it is treated
Therapist helps family disentangle transference, using
interpretation to promote insight.
Easier to promote insight into transference patterns in family
therapy because patterns happen “live.”
Diane R. Gehart
Ledger of Entitlement and Indebtedness
Ledger of entitlements and indebtedness
Internal accounting of what one is due and what one owes
others.
Justice and fairness: Monitoring fairness is ongoing process that

keeps relationship trustworthy.
Entitlements: “Ethical guarantees” to merits that are earned in
the context of relationships. Destructive entitlements result
when children don’t receive nurturing and later project this loss
onto world, which is the “debtor.”
Invisible loyalties: May manifest as indifferences, avoidance, or
indecisiveness in relation to object of loyalty.
Revolving slate: Destructive process where one takes revenge in
a relationship based on relational transactions in another.
Split loyalties: When child feels forced to choose one parent
over another because of mistrust between them.
Legacy: Transgenerational mandate linking endowments of
current generation to obligations to future generations.
Diane R. Gehart
Mature Love: Dialogue Versus Fusion
Mature love
Dialogue between two people conscious of family dynamics that
have shaped them.
Fusion
Experienced as amorphous “we” like infant and caregiver.
In Therapy
Invisible loyalties made overt; to be critically examined.
Allows conscious choice/action rather than fear/anxiety
characterizing fused relationships.
Diane R. Gehart
Targeting Change: Goal Setting

Diane R. Gehart
Goals
General goals
Increase autonomy by making unconscious processes conscious.
Decrease interactions based on projections.
Increase capacity for intimacy without loss of self.
Develop reciprocal commitments including fair balance of
entitlements and indebtedness.
Diane R. Gehart
The Doing: Interventions
Diane R. Gehart
Listening, Interpreting, and Working Through
Three generic interventions
Listening and empathy: Listening objectively to client’s story
without offering advice, reassurance, validation, or
confrontation.
Interpretation and promoting insight: Encourage insights by
offering interpretations to client, such as analyzing ledgers of
entitlement.

Working through: Process of translating insight into new action
in family and other relationships.
Diane R. Gehart
Eliciting
What it is
Using clients’ spontaneous motives to move family in a
mutually beneficial and dialogical direction.
How it works
Therapist facilitates process by:
Integrating facts of the situation, each person’s individual
psychology and interactive transitions.
Helping family rework balances of entitlement and
indebtedness.
Helping members to reinterpret past interactions and identify
new ways to move forward.
Diane R. Gehart
Detriangulating
How it works
Identify where parents have triangulated a symptomatic child
into relationship to deflect attention from couple distress.
Once child’s role is clear, child dismissed from therapy and
couple works to address issues that created child’s symptoms.

Diane R. Gehart
Family-of-Origin Therapy
Three-stage model for couples
Couples therapy: Work with couple alone to increase insight
into personal and relational dynamics.
Couples group therapy: Couple join couples group, receive
feedback from other couples and also view their dynamics.
Insight comes more quickly when problem dynamic acted out in
another couple.
Family-of-origin therapy: Each member of couple invited to
have four-hour-long session with his/her family of origin.
Sessions used to clarify and work through past and present
issues.
Diane R. Gehart
Tapestry Weaving: Working with Diverse Populations
Diane R. Gehart
Gender Diversity: The Women’s Project
What it was
Betty Carter, Olga Silverstein, Peggy Papp, and Marianne
Walters promoted awareness of women’s issues in field of
family therapy.

Raised issue of gender power dynamics and identified how
therapists were reinforcing detrimental stereotypes.
Therapists should be agents of social change, challenging sexist
attitudes and beliefs in families.
Reducing sexism
Discuss gender role expectations of each person and point out
beliefs that are unfair or unrealistic.
Encourage women to take private time for themselves.
Use self-of-the-therapist to model an attitude of gender
equality.
Push men to take equal responsibility in family relationships
and household.
Diane R. Gehart
Ethnicity and Culture Diversity
Working with different cultures
Therapies aimed at “thinking” or psychologically-minded
clients.
Minority groups preferring concrete suggestions may have
difficulty.
Therapist’s stance as expert fits expectations of many
immigrant populations.
Emphasis on intergenerational patterns may be useful with
clients whose cultural norms value extended family.
Greatest danger is therapist using inappropriate cultural norms
to analyze family dynamics.
Diane R. Gehart

Sexual Identity Diversity
Issue of a child’s sexual orientation and gender-identity has
implications for entire family system.
Pay particular attention to intergenerational relationships.
Gay and lesbian parents lived closer to and received more
support from their own parents (Koller, 2009).
Gays and lesbians who were not parents reported stronger
connections with their friend networks (family-of-choice).
Parental disapproval on lesbian relationships has positive and
negative effects on the relationship (Levy, 2011).
Negative effects include amount and quality of time spent as a
couple, stress on the couple relationship, emotional impact on
couple, fear/uncertainty, communication problems, and sexual
effects.
Positive effects of parental disapproval of the relationship
included increased couple closeness, communication, patience,
maturity, and valuing of the relationship.
Twice as many parents of gay/lesbian children had significant
marital issues and twice as many heterosexual men had more
distant relationships with their fathers than gay men (Feinberg
& Bakeman, 1994).
Diane R. Gehart
Sexual Identity Diversity (cont.)
Psychodynamic therapy has long been criticized for its
pathologizing of same-sex attraction.
Therapist should consider using gay-affirmative approaches
(Rubinstein, 2003).
Consider a multifaceted identity formation that includes,
biological sex, gender identity, social sex-role, and sexual
orientation.

Social sex-role confusion is often the most salient issue for gay
and lesbian clients, who often feel conflicted over conforming
to culturally approved behaviors for maleness and femaleness.
Can help GLTBQ clients address internalized homophobia by
exploring their personal meaning of being attracted to same-sex
partners.
Diane R. Gehart
Research and the Evidence Base
Relation supported between differentiation and chronic anxiety,
marital satisfaction, psychological distress.
Little support for theories on sibling position.
Triangulation received partial empirical support.
Bowen’s differentiation of self has been focus of research on:
Client perceptions of therapeutic alliance.
Adolescent risk-taking behaviors.
Parenting outcomes in low-income urban families.
Adult well-being.
Support provided for emphasis on self-of-the-therapist.
Study identified two aspects of differentiation:
Affect regulation, Ability to negotiate interpersonal
togetherness with separateness
Diane R. Gehart

Reflect on the most important things you learned from Accounting E.docx

Reflect on the most important things you learned from Accounting E.docx

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