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202 terms

Systems Theory and Family Therapy

STUDY
PLAY
Homeostasis
Concept of homeostasis was one of the first concepts that guided family therapy
The idea that families tend to resist change in order to maintain a steady state.
Balance is maintained through homeostasis.
Other approaches may call this "resistance"
Family therapists believe this is what keeps individuals and families stuck in cycles and/or behaviors
-Someone always needs to maintain one of the roles to keep Homeostasis going
Process vs. Content
Two different areas of focus
Content: what is being said
What the argument is about (eg., curfew)
Process: the deeper meaning, message, and interactions used
How the family argues?
What messages are sent?
Mom withdraws, Dad lectures, Kid is aggressive
The temptation is to get caught up in the content!!
Role Theory
What roles are family members expected to play?
Very difficult for family members to stop playing these roles
-The perfect child
-The rebel
-The athlete
Others??
Roles may become reinforcing:
The good child is always good and the bad is always bad because neither gets the opportunity to be the other
Child Guidance Emphasis
Kids were historically treated individually ... families were viewed as an extension of children
Mothers were sometimes seen separately from their children but the social workers/psychiatrists did not collaborate
Parents were frequently blamed (esp. mothers)
Term: schizophrenogenic mother- Thought that mothers cause schizophrenia- 1950s
Bowlby worked some with families.. But Nathan Ackerman was the one to take the lead
The Palo Alto Group
Gregory Bateson/Schizophrenia Research
Don Jackson & Jay Haley
Focus on communication
Meta-communication
2 levels of communication/messages
Report and Command
Meta-communication is the implied command
E. g.,: clean your room (message is "you never do anything right and I have to remind you of everything")- layered communication; listen on multiple levels
Or: I thought you were going to call when you got off work.
Double Bind (Palo Alto Group)
First identification of the family's influence on behavior
observed initially in schizophrenic individuals
This idea of "do this but don't do this"
Contradictory messages within an intimate relationship that lead to conflict
Example: mom stiffens when son gives a hug, son withdraws, mom says "don't you love me?", son embarrassed, mom criticizes son's feelings
-Wife that says "please do the dishes, then says why aren't you spending time with me?"
Don Jackson
Identified family homeostasis
Complementary relationships
Don Jackson
Partners are different but they fit (like a puzzle)
Logical, emotional
Weak, strong
Symmetrical relationships
Don Jackson
Based on symmetry and equality
eg: both work, share chores, etc.
Family rules
Don Jackson
Idea that families follow the underlying rules - and only use a small range of behaviors

Identified that family patterns maintain symptoms
-Functional vs. Problematic
-Asking the family what secondary gains would be
-Secondary Gain: Dealing with the root problem

Scapegoat
-May be the "identified patient"- the one that "brings" the family into counseling
-Idea that families take out symptoms on one individual
-Frequently the child (can also be viewed as the symptom carrier)
Jay Haley
Family communication
-Different levels of communication at the same time
Go clean your room ... what does it really mean?
Directive therapy
-Telling people to do what they fear
Virginia Satir
First family therapist to really look at emotion
Focus on communication and emotion
Conceptualized families as stuck in narrow roles
Goal was to free family members from these roles
Theodore Lidz
Did not believe that mothers caused schizophrenia
Identified 2 types of marriages - both leave kids feeling responsible to balance the marriage
Psuedomutuality
Lyman Wynne
"a façade of togetherness that masks conflict and blocks intimacy"
No room for uniqueness or separateness
Avoidance of deep, intimate relationships
Psuedohostility
Lyman Wynne
Arguing and bickering that hides "pathological alignments" in families
Appears to be separateness but that is a façade
Prevents open communication and quality relationships
Marital Skew
Theodore Lidz
-One parent is a "pathologic bully" and the other is passive/dependent; think military father
-Example: Self-centered father appearing as dominant but is actually very bullying
Marital Schism
Theodore Lidz
-Husband and wife undercut each other's worth and/or compete openly for attention/affection of the children
Example: Devon (presented as a child problem)- parents fought over who took the best care of their child
"Rubber Fence"
Lyman Wynne
Observed in these families
Keep outsiders out, and insiders in... with the appearance of being open
These families became "sick little societies"
May present as seeking help... but not let clinician in
Murray Bowen
Father of the genogram
Initially specialized in schizophrenia - Menninger Clinic
Heavy emphasis on theory, less emphasis on intervention

Differentiation of self
-Independence from others - emotionally, cognitively, etc.

Triangles
-Bringing in a 3rd person to relieve tension (Amanda's example of her friends Sara and Kristi)

Emotional reactivity of families
-Inability to think clearly because of emotion
Families will pull therapists into this emotion
Nathan Ackerman
Forerunner in promoting family therapy

Unique in that he focused both on family relationships and individual considerations

Therapy including provoking families to address issues commonly avoided (such as sex and aggression)- usually danced around in family therapy

"He never lost sight of the self in the system."
Salvador Minuchin
Identified 2 patterns in families
Both patterns lack clear authority

Enmeshment
Parents over-involved; no hierarchy or line between parent and child

Disengagement
Parents not involved
First order change
Minuchin
Superficial change
Eg: I bought you flowers because I hurt your feelings
Second order change
Minuchin
A change in the system itself
More lasting and concrete
Eg: I stopped berating you in public because I understand how it impacts you
Carl Whitaker
Referred to as "irreverent"
"turned up the emotional temperature" in therapy
Ivan Boszormenyi-Nagy
Psycho-analytical roots
Father was an accountant
Contextual therapy
Cybernetics
The tendency of families to maintain stability

Feedback loop
How a family gets information to maintain stability - steers the family towards homeostasis
-Example: husband takes out the trash, wife nags, etc.; it is an interaction that repeats itself every week

Negative feedback
Return to stability or normal - no new information
Status quo within the family- maybe the husband doesn't get angry and instead ignores the wife, but still takes out the trash.

Positive feedback
Attempt to change - only means new information, not necessarily good/positive
2 outcomes: former homeostasis OR new homeostasis
Common response: getting back to normal
Death, fighting, graduation, re-marriage
Cybernetics
Focus on the following:
Homeostasis
Family rules
Negative feedback
Positive feedback
Sequences of family interaction

See the model in the first day power point that models the cycle
Attachment Theory
Developed by John Bowlby
Based on the concept that we have an innate need for others

We seek closeness of others when we are stressed

Definition:
Biological, psychological, & social connections between a child and caregiver(s)

"Will you be there for me?" "Can I depend on you when I need you?"

How the caregiver(s) responds to these questions sets the stage for attachment.

Smiles, eye contact, touch, holding, positive affect, rocking, etc.
Working Concepts
People are products of their context - specifically the family but can be applicable in other contexts

There is complementarity in relationships: behaviors are linked together, patterns occur, we are influenced by others

Linear causality versus circular causality - Linear looks at finding a root of a behavior versus a repeating cycle
Cause and effect versus cycles

Process versus content
How people talk versus what they talk about

Triangles
Means to alleviate anxiety
Working Concepts Continued...
Family Structure
-The organization of the family
Subsystems (THIS IS WHAT WE REALLY WANT TO KNOW ABOUT)
-Parents
-Kids
-Athletes
-Other ideas?

Boundaries- "I talk to Mom about this and Dad about this"
-Lines within families that explain how to communicate, act, express emotion
-Disengaged
-Enmeshed
Leaving home: single young adults
Accepting emotional & financial responsibility for self
Changes Required:
Differentiation of self
Develop intimate relationships
Establish self in work & financial independence
Marriage: the new couple
Commitment to new system

Changes Required:
Formulation of marital system
Realignment of relationships with extended family and peer group
Families with young children
Accepting new members into system

Changes Required:
Adjusting marriage to make space for kids
Joining in new tasks
Change in relationships: parenting and grandparenting
Families with teens
Increasing flexibility of boundaries to enhance children's independence and grandparents needs

Changes Required:
Shifting of relationships to allow teen to move in/out of system
Refocus on midlife marital and career issues
Caring for grandparents
Launching children and moving on
Accepting numerous exits and entries into system

Changes Required:
Renegotiation of marriage
Renegotiation of parent/child relationship
Including in-laws and grandchildren
Dealing with grandparents
Families in later life
Accepting the shifting generational roles

Changes Required:
Maintaining marriage
Focus on middle generation
Supporting older generation
Dealing with loss
Types of Genograms
Can do genograms to focus on
Mental health
Spirituality
Messages
Physical health
Relationships

Genogram as intervention
Increase awareness
Finding patterns
Psycho-education
Resilience: Froma Walsh
3 major areas of resilience
Belief Systems
Organizational Patterns
Communication and Problem Solving

Goals of the resilience perspective
Decrease family risk factors
Reduce negative chain reactions that heighten risk for sustained impact and further crisis
Strengthen protective family processes and reduce vulnerabilities
Bolster family and individual pride through successful problem mastery

-Families that don't have resilience usually get stuck in the system.
#1 Belief Systems (Resilience)
How the family views a crisis, suffering, or options

Making Meaning of Adversity
Families view it as a family problem vs. individual problem
Normalizing stress vs. being victimized (believing that bad stuff will happen; how are we going to make sense of it) (Resilience comes from accepting that we live West of Eden)
Coherence: work together, look at context

Positive Outlook
Sense of hope, learned optimism
Helps to encourage families strengths during a crisis
Accept what can't be changed

Transcendence and Spirituality
-Connection with something larger- making sense of the nonsensical
-Faith community
-Inspiration

Paradox of Resilience
-The worst of times can also bring out the best
#2 Family Organizational Patterns (Resilience)
How the family organizes to meet challenges

Flexibility (Metaphor of a tree; the branches can move and sway and still stay rooted)
-Openness to change
-Stability through disruption
-Strong authoritative leadership (provides the stability)
--Nurturing, protecting, guiding
--Cooperative co-parenting, equality in parental subsystem
#3 Communication and Problem Solving (Resilience)
Clarity in a crisis, emotional expression

Clarity
Clear and consistent messages (verbal and nonverbal)
Clarify ambiguity - speak the truth (say what you mean, do what you mean)

Open Emotional Expression
Emotions are accepted
Empathy, humor
Responsibility for personal emotions
Little blaming

Collaborative Problem Solving
Brainstorming (coming up with a plan to attack/defend against the system)(example of prof's grandmother preparing to die and the family talking about it)
-Shared decision making, negotiation, fairness
-Conflict resolution
-Create a concrete plan to solve the problem
-Prevention of problems
McCubbin's Family Stress Model
Developed by husband and wife
Found resiliency factors that help a family maintain resilience in the presence of stressful events
McCubbin: Ten general resiliency factors - both protective and recovery
1. Family problem solving and communication
2. Equality
3. Spirituality
4. Flexibility
5. Truthfulness (truth from family as well as agencies, doctors, etc.)
6. Hope (can things be better in the future?)
7. Family Hardiness
8. Family time and routines
9. Social support
10. Health
Froma Walsh: Practical Principles
"No single thread distinguishes well-functioning from dysfunctional families, as pioneering studies have found."

"When clinical formulations reduce the richness of family interactions to simplistic labels such as 'an enmeshed family', an alcoholic family', 'a codependent family', they both stereotype and pathologize families." -systemic therapy steers away from labeling people; labels keep us from seeing people as complex

"Instead, mental health professionals must attend to the many strands that are intertwined in family functioning, and need to assess strengths and vulnerabilities on multiple system dimensions.
Good way to think about systems
one of those planets projects from elementary school. you can pull down Jupiter and work with it, but if you don't change the whole system, Jupiter is going to have a hard time staying changed, unless it intentionally affects change
Systemic Assessment
Can occur with individuals, couples, or families

Does not focus solely on individuals- there's always a bigger story going on

Focus on relationships- dynamics that affect each person

Considers dynamics
-within the family
-Relationships
-Interactions
-outside of the family
-Church, Extended Family, Neighborhood, School, etc.

How do these dynamics impact:
Individuals within the family
The family as a whole
More Systemic Assessment
Multidimensional
Contextual (are they coming to you in the midst of a tragedy, etc.)
Process/content
Sequential/priority (What is top priority? example: getting a daughter to come out of her room)
Responsive to family needs
Two major questions of each theory
Family Processes
What are the explicit and implicit assumptions about normal - typical and optimal - family functioning and views of dysfunction?

Therapeutic Goals and Change Processes
How do these beliefs influence therapeutic goals and objectives and intervention processes?
Systemic Assessment Application
Family Processes
What are the explicit and implicit assumptions about normal - typical and optimal - family functioning and views of dysfunction?
What do you consider to be "normal" family functioning?
What are signs of health in families?
What do you consider to be "dysfunctional" family functioning?
What are red flags or signs of struggle?
Systemic Assessment Cont...
Research is showing the multiple family configurations can be functional...

It is less about the actual formation of the family

MAIN POINT: The functionality of the family is more about communication, family processes, and relationship quality.

Do not be quick to assume that the form of a family is an indicator of its functioning (like don't assume a family with step-children/parents is going to be bad)
Assessing for family's view of functioning
How do members view their own family as a system and each individual?
How do they believe others view the family?
How do they believe others view the individuals within the family?
How do they compare their family to other families?
How do they compare their family to overall society's views on families?
Holistic assessment:
Obtain perspective of each family member

Who is identified as a family member?
Not always a "blood" relative
Explain that family does not have to mean "household"
Examples: nanny, coach, college student

Genogram can be a good assessment tool

Family time lines can help identify important events and/or symptom presentation

Include previous family subsystems (divorce, dating, remarriage)
Anticipated future changes
Especially consider changes in the family household
Areas to consider in your assessment:
Belief systems of the family
-Shared or different- does everyone share that belief system?
-Not just spiritual beliefs
-Beliefs of change
-Beliefs of ability to handle crises
-Beliefs of strengths of the family and/or individuals
-Family themes
Achievement
Money
Status
Athleticism
Legacy
Areas to consider in your assessment:
Organization Patterns of the family
Flexibility
Is the family dependable?
How does it respond to change?
Rigid interactions?

Connectedness between members (health is usually a midway point between enmeshed and disengaged)
Boundaries
Trust, respect
Leadership
forgiveness

Social and economic resources (job changes can change the family system)
Extended family
Community networks
Areas to consider in your assessment:
Communication Processes of the family
Clarity of communication
Messages are not ambiguous
Expectations are clear

Open emotional expression
Emotional reciprocity
Individuals allowed to have emotions that differ from others

Collaborative problem solving
Shared decision making; brainstorming
Prevention of problems
Conflict resolution
Global Assessment of Relational Functioning
Relational guide to levels of functioning
Global Assessment of Relational Functioning (GARF)
Added to the DSM-IV in 1994
Rate the degree to which a family or other ongoing relational unit meets the affective or instrumental needs of its members in the following areas:
Global Assessment of Relational Functioning: 3 areas of assessment
Problem solving: skills in negotiating goals, rules and routines; adaptability to stress; communication skills; ability to resolve conflict

Organization: Maintenance of interpersonal roles and subsytem boundaries, hierarchical functioning, coalitions and distribution of power,control and responsibility

Emotional Climate: tone and range of feelings; quality of caring, empathy, involvement, and attachment/commitment, sharing of values; mutual affective responsiveness, respect, and regard; quality of sexual functioning
Global Assessment of Relational Functioning: Rating Scale
81-100 Relational unit is functioning satisfactorily from self report of participants and reports of observers
61-80 functioning of relational unit is somewhat unsatisfactory. Over a period of time, many but not all difficulties are resolved without complaints
41-60 Relational unit has occasional times of satisfying and competent functioning together, but clearly dysfunctional, unsatisfying relationships tend to predominate
Global Assessment of Relational Functioning: Rating Scale
21-40 Relational unit is obviously and seriously dysfunctional; forms and time periods of relating are rare
1-20 Relational unit has become too dysfunctional to retain continuity of contact and attachment
Circumplex Model
David Olson - stems from his research on families and pre-marital couples
Assesses both couple relationship and family of origin
Two Axes:
Flexibility
Closeness
Circumplex Model
Hypotheses of the model
Balanced couples and families will generally function more adequately across the family life cycle than unbalanced types.
Not functioning in extremes of either flexibility or closeness
If a couple's/family's expectations or subcultural group norms support more extreme patterns, families can function well as long as all family members desire the family to function in that manner.
Circumplex Model
Hypotheses of the model
Positive communication skills will enable balanced types of couples/families to change their levels of cohesion and flexibility.
Poor communication prevents movement in families
Couples/families will modify their levels of cohesion and/or flexibility to deal effectively with situational stress and developmental changes across the family life cycle.
Circumplex Model: Closeness
"Balanced couples and families tend to be able to balance their separateness (I) versus their togetherness (We)."
Couple and family closeness is measured by:
Separateness/togetherness
Closeness
Loyalty
Independence/dependence
Circumplex Model: Closeness
Unbalanced: Disconnected
- too much (I) separateness
- little closeness
- lack of loyalty
- high independence
Balanced: Somewhat Connected to Very Connected
- good I-We balance
- moderate to high closeness
- moderate to high loyalty
- interdependent
Unbalanced: Overly Connected
- too much (We) togetherness
- too much closeness
- loyalty demanded
- high dependency
Couple Closeness (Circumplex Model: Closeness)
We really like to do things with each other.
We ask each other for help.
We spend too much time with our friends or relatives.
We share hobbies and interests.
Jealousy is an issue in our relationship.
My partner & I really enjoy spending our free time together.
We feel very close to each other.
We find it easy to think of things to do together.
We consult each other on all important decisions.
Our togetherness is a top priority for us.
Family Closeness (Circumplex Model: Closeness)
Family members ask each other for help.
Family members approve of friends.
Our family likes to do things with each other.
Family members enjoy being together.
Our family likes to spend free time together.
Family members feel close to one another.
When our family gets together for activities, everyone is present.
It is easy for us to think of things to do together.
Family members consult on decisions.
Family togetherness is very important to our family.
Circumplex Model: Flexibility
"Balanced couples and families tend to be able to balance their stability versus change."
Couple and family flexibility is measured by:
- stability versus change
- leadership
- roles
- discipline
Circumplex Model: Flexibility
Unbalanced: Overly Flexible
- too much change
- lack of leadership
- dramatic role shifts
- erratic discipline
Balanced: Somewhat Flexible to Very Flexible
- can change when necessary
- shared leadership
- role sharing
- democratic discipline
Unbalanced: Inflexible
- too little change
- authoritarian leadership
- roles seldom changed
- strict discipline
Circumplex Model: Flexibility
Couple Flexibility
We compromise when problems arise.
We are creative in how we handle our differences.
In our relationship, we share leadership equally.
Both of us are able to adjust to change when it's necessary.
We try new ways of dealing with problems.
We make most decisions jointly.
We seldom seem to get organized.
We will share household responsibilities equally.
We have difficulty completing tasks or projects.
We are flexible in our lifestyle.
Circumplex Model: Flexibility
Family Flexibility
Family members compromise when problems arise.
Our family is flexible in how discipline is handled.
When there are problems, our family becomes disorganized.
Things never seem to get done in our family.
Our family is able to adjust to change when necessary.
Parents and kids make decisions together in our family.
Our family has a hard time finding good ways to solve problems.
Our family shifts household responsibility from person to person.
We never seem to get organized in our family.
Our family has a rule for every situation.
Circumplex Model
Examples
For further information...
Prepare-Enrich Online
Chapter 19 Walsh text
Article on Angel
Basic Techniques of Family Therapy
Case Conceptualization
Life Cycle
Interaction Patterns
Cultural Factors (even the culture of the family)
Ethical Concerns (family secrets) (How am I ethically obligated to handle certain information?)
Assessments
Genogram
Earlier lecture
Begins with first phone call (who's making the phone call?)
Who comes to session?
Who talks more?
Verbal and nonverbal communication
Process vs content
Joining
-the process of connecting with those in your office in a way that gives you permission to call them on things.

Make an attempt to connect with each individual on some level
Your goal is to establish a safe environment for the family and the individuals
Part of this is your empathy, therapeutic stance
Another part is your curiosity
Getting the perspective of each family member
Curiosity
What is bringing this family in at this specific time?

Assess for interaction patterns (circular vs. linear)

Listen for process vs. content

Very important to get each person's perspective

How are other systems impacting the family?

What is family structure like?
First session checklist
Listen to each family member's point of view- don't let one person talk the whole time
Establish leadership - pacing and control; you have to be the one in charge
Working alliance
Identify resilience and strengths
Empathy
Identify problems and solutions
Develop hypotheses- you're always working on a hypothesis
Assess for extended family or other members
Explain Treatment- "They're may be times when I just work with your daughter, but sometimes I'll want to see you as parents."
Ask for questions
Early Phase Checklist
Identify major conflicts and identify them
Treatment plan
Balance focus on problem, interpersonal relationships
Homework
Identify family roles
Push for change in session and out of session
Middle-phase checklist
Increase intensity in session (balance with empathy)
Balance of direct and indirect communication with family
Increase individual responsibility within system
Strengthen family bonds
Assess therapist role
Maintain systemic perspective (be ready to watch someone revolt at the attempt of changing the system)
End-phase checklist
Is presenting problem improving/decreasing?
Is family happy/satisfied with treatment?
Family able to articulate progress?
How is family handling current stressors?
Are relationships within and without family system strengthened?
Predict future problems.
Transgenerational Therapy
Murray Bowen
Can be used with couples, families, and/or individuals

This theory is heavy on theory rather than intervention ... and is frequently intertwined with other models

Differentiation of self
Triangulation
Multigenerational Transmission Process
Emotional Cutoff
Nuclear Family Emotional System
Family Projection Process
Sibling Position
Societal Emotional Process
Differentiation of Self
main definition: the ability to experience difference
the self in relation to, but separate from, others
The ability to distinguish one's own thoughts and feelings as separate from others
within the marital relationship, differentiation includes outside relationship with others but also a solid relationship with the spouse
"In order to have resilience, partners have to possess a strong sense of personal identity that is not threatened by change." (p124)

Differentiation is the cornerstone for healthy long-term commitments
Individual differentiation influences the choice of the spouse
A healthy marriage includes two individuals who are able to have a caring connection with FOO
Bowen asserts that each individual brings his/her family of origin into the marriage
Triangulation (Bowenian)
Couples (or a family dyad) bring in a third party to relieve the anxiety within the dyad
Concept: couple as two poles, back and forth, when becomes unstable, bring in a third party for balance and stability
This third party becomes the boundary keeper (or peace keeper)
Most common third party is a child
Other triangles: affair, in-law, therapist, co-worker
Examples: mom-child dyad, dad in peripheral
wife-husband dyad, mom-in-law in peripheral
mother-child dyad, sibling in peripheral
Often a source for affairs
Triangulation Continued...
Secondary triangles: when 2 or more individuals ally as one corner of a triangle temporarily, on perhaps 1 issue only.
Example: initial triangle of mom, dad, and son; MGM sides with mom and son on an issue, creating a secondary triangle
The third person in the triangle is frequently pushing for change
Example: child is acting out at school because of triangulation with mom-dad dyad
Class discussion: Examples of triangles? Either in personal life or in media
Multigenerational Transmission Process (Bowenian)
The concept that levels of differentiation are taught (implicitly and explicitly) to younger generations of family members
As a result, family members become less and less differentiated as time goes on
Example: If a married couple focuses on one of their children excessively, this child will marry a similar individual with low differentiation. They will transmit this to their child, and the pattern will continue among generations.
Bowen saw this with the schizophrenic families he was working with
Low differentiation within a family system can lead to marital distress, dysfunction in a spouse, or dysfunction with a child
Emotional Cutoff (Bowenian)
May occur by moving away, isolation, or emotional avoidance
This can stem from being emotionally fused in relationships
Function of distancing is to maintain homeostasis or equilibrium
Common for fusion and cutoff to both exist in the same extended family
This is a "flight from an unresolved emotional attachment" per Bowen
Emotional cutoff can be either physical or emotional
It takes 2 people to maintain the cutoff
Emotional Cutoff Continued... (Bowenian)
Cutoff can be considered as a continuum
The mild form is part of differentiation
Establishing distance in order to create differentiated self
The extreme is cutoff
The mid form is "tearing away" in order to create a psuedo self (The teenager raised in the church that becomes an atheist)
This is different from "growing away"
Examples of the process of cutoff:
Not communicating due to distance
Avoiding communicating bad news
Increased conflict prior to separation (launching)
Being different from parent in order to increase emotional distance
Choosing not to acknowledge birthdays, anniversaries, or family events
No eye contact or verbal communication
Not using individual's name
Not initiating contact (but responding to it)
Not initiating contact or responding to it
Nuclear Family Emotional System
4 basic relationship patterns that can lead to problems within the family system
Present in multiple family structures (not just the nuclear family)
Family tension arises when external or internal stressors occur: tension appears in the form of anxiety within one of the patterns below:
Marital conflict
Dysfunction in one spouse
Impairment of one or more children
Emotional distance (fusion - little overt conflict)

The anxiety within one of these four relationship subcategories may be what brings the family or marital dyad into therapy
Consider... where does the anxiety present within this family?
Case examples:
Danny (22yo male from a successful family)
Luke (18yo male at USN)
The perfect family you may never see!
Family Projection Process
Parents transmit/project anxiety onto one of the children
Parents present with a calm marriage; over-concerned and concentrated on child (symptom carrier)
Family may bring child in for therapy when marital therapy is actually needed
Experiential: Brainstorm on ways you may assess for this and then bring it up to the parents
Sibling Position
A concept not as commonly considered
Bowen believed that sibling position within FOO played out in marital relationship
Also contributed to family projection process: the child with anxiety projected onto them was oftentimes infantilized
Societal Emotional Process
Society's impact on family emotional processes
Consider current economical, political, cultural, and societal issues that may be impacting the couple or family
Example: A Bowen Couples Therapist would consider the influence on a recent school scandal and how it may be impacting the parent's anxiety about a child
Assessment (Bowenian)
Specific interventions not clearly articulated; this approach is heavy on theory
Remember that changes within the family system will radiate out to extended family of origin
Assessment occurs within first 1-3 meetings, Genogram will be major tool used for assessment
Assessment:Genogram
Genogram will include 3 generations
Used to point out patterns, current problems, problem history: mainly focusing on multigenerational patterns
Patterns may include mental health, physical health, work, spirituality/religion
Also looking for major/critical incidents, key figures in FOO, important events in FOO, and the history of the marriage (also think DATES or TIME LINES)
Have each individual give own perspective of presenting problem (including how FOO has responded to problem)

Genogram helps therapist think long-term regarding treatment goals
Therapist to be culturally aware when assuming health of FOO and system
Part of this awareness includes social class, religion, culture
The Clinical Interview (Bowenian)
-getting to know the individual and the family he/she comes from
Used to obtain each individual's view of problem
Therapist begins to develop FOO context/treatment frame as this will guide treatment
Each individual's view of the problem is important as it frames the emotional needs and problem definition - this is used to shape interventions
Important to obtain time frame of problems
Looking for distribution of power
Distribution of power can be observed in decision-making, financial issues, parenting
Include affective assessment: how does family relate? Is there physical touch? Look for nonverbal and verbal expression of emotion
Consider past needs/wishes that have been met or unmet and how they are currently impacting the family
The process question (Bowenian)
Goal is to slow the client down, decrease anxiety, and get the client to start thinking differently
Examples:
When your mom calls you and nags, how do you handle it?
What happens when your family is all together?
Is this a pattern in your dating relationships?
The I-position (Bowenian)
Rather than blaming or criticizing, the individual takes responsibility for his/her feelings and thoughts
Goal is to decrease blame and attack within relationships
Creating a TG Frame (Bowenian)
Creating a TG Frame by the use of a genogram as an intervention that encourages self-disclosure and vulnerability
Genogram allows families to learn more about and gain a new perspective of their own FOO and each other's FOO
Genogram helps create this TG frame as it puts an emphasis on FOO
Tracking the Presenting Problem
TG therapist is observing power distribution, decision-making, story-telling, naming of the problem
Structural characteristics of the family are observed: distance, fusion, disengagement, cutoff, conflict
Tracking Antecendents
TG therapist tracks problem while observing what event triggered the current problem
Consider antecedents within whole system as well as dyads and within each FOO
Tracking 3 generations of family - acknowledges another dimension of the experience and presenting problem
Helps clients get to the root of things: see how FOO had an impact on the current dilemma
Family of Origin Consult
TG therapist arranges the consult during the mid-phase of therapy
Helps family make the connection of problem to FOO
FOO meetings only occur once or twice due to financial/time constraints
2 hour segments over 2 consecutive days
Frequently increases anxiety so family needs to be prepared for this visit
One family of origin at a time
Spouse just observes and does not participate
Spouse invites own FOO to the experience
Siblings frequently do not attend (though they are asked)
Role of the Therapist
Build strong therapeutic alliance
Looking at things from inside the system and creating safety to explore topics
"Partiality replaces neutrality." Each individual knows the therapist is neutral
TG therapist is transparent: using self but remaining separate/differentiated.
Participant observer
Self-disclosure helps family understand that the therapist is real and has also experienced challenges
Disclosed material is resolved material so counter-transference does not occur
Role of the Therapist
Therapy occurs in stages/phases so therapist role changes
Therapist seen as coach throughout
In the beginning, more directive
Mid-phase, increased use of self as couples begin to look at key relational/FOO issues
Late-stage, less coaching/expert stance as couple begins to solve problems on their own
FOO Consults-Structure
Spouse being visited explains presenting problem within the marriage
FOO encouraged to ask questions and explain what they know (emphasis is on spouse and not on FOO)
Each consult is different, depending on emotional tone and communication of FOO
Some FOOs resistant to discuss whereas others jump right in
Consults often increase spouse's awareness of what he/she has brought to marriage
After a consult the spouse is frequently more self-focused and willing to look at his/her own contribution to current problem
Strategic Therapy
A broad category stemming from the communications model
MRI Brief Therapy
Haley & Madanes' Strategic
Milan Systemic
General concepts guide the theory, but interventions and therapist presentation may look different
Overview of Strategic Therapy
People are always communicating
You cannot NOT communicate!!
Process and content are always present
Consider the context of the communication
Family rules play a role
Rules maintain homeostasis
Circular Causality
Feedback loop always in motion
Main focus of this model (all 3)
Overview of Strategic Therapy Continued...
First order and second order change
Behavior change vs family rules change (or heart change)
Reframes
Making a different interpretation of the behavior
Eg: child seeking attention from parents rather than being an unruly child
Behaviors in families developed to maintain homeostasis:
Function of the system

Overall goal of therapy is to improve communication patterns
This can be done by identifying sequences OR by blocking the sequences
MRI Brief Therapy (Strategic Therapy)
Mental Research Institute
Started by Don Jackson
Virginia Satir
Jay Haley
John Weakland
Paul Watzlawick
Brief Therapy Project
Richard Fisch
Arthur Bodin
Jay Haley
John Weakland
Paul Watzlawick
Assessment (MRI Brief Therapy)
Define a resolvable complaint
Get a picture of the complaint - from each person involved
"If we had a video of this, what would I see?"
Identify attempted solutions that maintain the complaint
Helps develop conceptualization of interaction cycle
Understand the clients' language for describing the problem
Helps define interventions in the family's language
MRI Brief Therapy Continued...
Did not identify a clear picture of normality due to the broad variance in families
Goal: to eliminate problems
Focus on circularity in communication
Family may encounter a "problem" and how each member responds determines if it continues or not ... or if the family gets stuck in the pattern.
Failed attempts at problem solving maintain the "vicious cycle"
Role of therapist: one-down stance
Intervention (MRI Brief Therapy)
Introducing the treatment setup
Inquiring about & defining the problem
Estimating the behavior that is maintaining the problem
Setting goals for therapy
Selecting and making behavioral interventions
Termination

Reframe problems so family understands
Paradoxical interventions
-Symptom prescriptions: increase intensity of symptoms (or make more grandiose)
-Goals: for client to rebel or for family to get tired
-Example: act more angry as a family... family gets tired, thinks it's ridiculous, or finds alternative solutions; the mother knows her daughter is going to throw a fit in the grocery store and tells the child "is that all you got?"
Strategic Therapy: Haley and Madanes
Jay Haley
Worked with MRI, then studied with Minuchin, then developed his own model
More strategy and a sense of almost manipulation in his view of therapy
Cloe Madanes
worked at both MRI and Child Guidance (with Minuchin)
Considered to be one of the most creative therapists of our time
Assessment (Haley and Madanes)
Problem definition
From view of each involved
Structural arrangements within the family
Triangles and coalitions
What is the payoff for each member?
Is power obtained? Attention?
Strategic: Haley and Madanes
Identified a concept of normalcy within families. Goal was to create more functional boundaries and hierarchies.
Rules within parental hierarchy set the tone for the family (for example, the parents shut the door every night; or Summer wanting me to read to her during dinner)
Haley believed that problems frequently stemmed from "disturbed hierarchies" within families
Interventions were specific to the family ... and creativity was a heavy influence
Strategic: Haley and Madanes
Haley & Madanes believed that labeling the problem or telling the family what to do leads to resistance
Madanes: "If a problem can be solved without the family's knowing how or why, that is satisfactory."
Haley focused on the meaning of the problems, interactions, and behaviors.
Also focus on power distribution within the family

My note: Different from Bowen because the therapist does things without telling the client why; there is no psycho-education involved. All SYMPTOM focussed
Prescribing the symptom (Haley and Madanes)
Telling a client to do a problem behavior
Shifts the behavior from involuntary to voluntary
Two possible outcomes:
Does the behavior and proves it is voluntary
Gives up the behavior all together
Considers the interpersonal payoff of the behavior
Metaphor (Haley and Madanes)
Behaviors are frequently metaphors within the family
Relationships may also replicate others
Pretend Techniques (Haley and Madanes)
Have family to pretend to have the symptom together.
Eg: telling lies
Prescribing Ordeals (Haley and Madanes)
Suggesting family members to do something each time a behavior occurs
Eg: Insomniac has to clean or pay bills when can't sleep
Eg: page 112 book
Cloe Madanes on Couples Therapy- video clip
Milan Systemic Model (Strategic Therapy)
Italian Psychotherapists
Mara Selvini Palazzoli
Luigi Boscolo
Gianfranco Cecchin
Guiliana Prata
Focus started on eating disorders ... then led to the incorporation of the family
Included male-female co-therapists and observers
Therapists have an attitude of neutrality: rather than having preconceived notions of normal, ask questions that lead to families examining selves ... with the hope that families would reorganize themselves.
Assessment (Milan Systemic Model)
Therapist starts with a hypothesis
Confirmed or disconfirmed in 1st session
Based on "identified patient"
Assessment questions focus on family as a set of interconnected relationships
Goal: develop a systemic perspective of problem
Intervention (MIlan Systemic Model)
Presession- involves family and clinicians
Session
Intersession- therapists talk to the observing team
Intervention
Postsession

All in one session
Positive connotation (Milan Systemic Model)
Identify positive impact of behaviors - how it's protecting the family
Presented to family as a hypothesis ... including how behavior is protecting the family
Eg., thanking the child for being symptom carrier- a better way might be to thank the child for serving the role rather than carrying/performing the symptom
Family rituals (Milan Systemic Model)
May have family do a ritual that's different from symptoms (eg., quality time)
Thanking symptom carrier for having symptom
Invariant prescription (Milan Systemic Model)
Asking parents to have mysterious communication
Inform the kids that a secret exists
Continues until symptoms stop
-reestablishes the parental hierarchy; could really change a child that is bossing the parents.
-then the therapist could create a session with the child about what they think/fear the assignment is about
Circular Questioning (Milan Systemic Model)
Used to highlight differences among family members
Example page 114- shifting from the child being the problem to a circular interaction that looks at a bigger picture
Boundaries (Structural Therapy)
Rules for managing physical and psychological distance

Clear boundaries
Refer to a range of normal - a balancing of closeness and distance

Enmeshment and Diffuse Boundaries
-Overly involved leading to symptoms
Disengagement and Rigid Boundaries
-Overly distant leading to symptoms
Structural Therapy
Minuchin
Enactments (Structural Therapy)
Technique where therapist prompts family to reenact a conflict or other interaction- Dr. Grieme actually gets her families to fight- you see so much in an argument
One of the most important techniques to master
Occurs in three phases:
-Observation of Spontaneous Interactions
-Eliciting Transactions
-Redirecting Alternative Transactions
Benefits of Enactments (Structural Therapy)
Providing in vivo practice and experience with new interactions and family patterns
REDUCING THE ILLUSION that the problem belongs to a single person
Increasing the family's sense of competence and strength by successfully engaging in new preferred behaviors (highlighting the things they're doing well)
Structural Therapy Contributors
Salvador Minuchin
Originator of structural therapy, psychoanalytic work emphasized interpersonal relationships
Wiltwyck School
He and colleagues Dick Auerswald, Charlie King, Braulio Montalvo, and Clara Rabinowitz worked with families
Jay Haley Collaboration
1962, Minuchin visited the MRI befriending Jay Haley becoming an influential relationship developing the Structural and Strategic approaches of family therapy

Influential students & colleagues
Harry Aponte, Jorge Colapinto, Charles Fishman, Jay Lappin, and Michael Nichols,
Marion Lindblad-Goldberg
Succeeded Minuchin as Director of Philadelphia Child & Family Therapy Training Center
Developed empirically supported Ecosystemic Structural Family Therapy
Jose Szapocznik
Colleagues develop empirically supported Brief Strategic Family Therapy (BSFT)
Three main phases of structural therapy (Structural Therapy)
1. Join
The family accommodate to their style (build an alliance)- finding ways to join/align with people; establishing a safe place
2. Map
The family structure, boundaries and hierarchy (evaluate and assess)
3. Intervene
To transform the structure to diminish symptoms (address problems you identified in the assessment)
Overview of Structural Therapy
Generally therapists will alternate between phases two and three many times revising and refining
Structural therapists prefer to begin therapy with the ENTIRE family to assess the system. After assessment, therapist may meet with specific subsystems (couple, child, individual, etc.)
The Therapeutic Relationship (Structural Therapy)
Joining and Accommodating
Joining as an attitude
Mimesis- using the language of the family
Therapeutic spontaneity
--Ability to be authentic and flow with therapy
Therapist use of self
"Make it happen"
--Play what role is needed
More recent adaptation: softer style
Case Conceptualization/Assessment (Structural Therapy)
Role of symptom in the family
Subsystems- looking at different relationships/roles within the family
Cross-generational coalitions
Boundaries
Hierarchy
Complementarity- if you have a good child, you need a bad child, etc.
Family life cycle development
Strengths
Goal Setting (Structural Therapy)
Clear boundaries between all subsystems allowing connectedness & differentiation within cultural contexts
Clear distinction between the marital/couple (as LOVERS) subsystem & parental subsystem (as PARENTS)
Effective parental hierarchy
Family structure promotes develop and growth
Interventions (Structural Therapy)
Systemic reframing
--Removes the blame from one person
--Identifies circular causality
--Re-describing the problem
Enactments & modifying interactions
Boundary making
Challenging family's worldview
Intensity and crisis induction (when you're really pushing a family- bringing feelings into the mix)
Unbalancing the Family System ("Okay Mom, you can't discipline this week. Only Dad can do that.)
Expanding family truths & realities (See things that are already healthy and capitalizing on it. If family night is working well, how can we do more of that?)
Compliments & shaping competence
Working with Diverse Populations (Structural Therapy)
Excellent support for working with diverse populations
Structural family therapy employs an active, engaged approach in which the therapist often takes an expert stance in relation to the family, an approach that often fits with the values of traditional cultures
Solution Focused Therapy
Best known strength-based therapies
Positive, active approach
--Help clients move toward desired outcomes.
There are two strands of practice which share many similarities
--Solution Focused Brief Therapy
--Solution-Oriented Therapy
Solution-Based Therapies: Overview
Brief therapy approaches influenced by
Mental Research Institute (MRI)
Milton Erickson's brief therapy and trance work
Strength-based
Popular with clients, insurance companies and mental health agencies
Solution-focused
Therapists spend a minimum of time talking about the problems
Instead focus on moving clients towards solutions
Myths of Solution-based Therapy
Myth #1: They propose solutions to clients (which amounts to advice giving)
--Client identifies solutions, therapists assist client in identifying solutions and they identify exceptions to the problem (when during your life do you not talk about the problem?), describe what is already working, and identify client resources

Myth #2 They never talk about the problem
--They spend less time talking about the problem
--They take their lead from the client
--Hallmark techniques, such as exception questions require they talk about the problem
Myths of Solution-based Therapy
Myth #3: They never talk about the past
--When they talk about the past, they focus on strengths
--Talking about the past is important - it helps to identify what has worked and what has not

Myth #4: Emotions are not discussed in therapy
--They do not view the expression of emotions as curative in and of itself (as with humanistic therapies)
--Instead, emotions are used as clues for works and where they want to go
Assessing Client Strengths (Solution Based Therapy)
Strengths include resources in a person's life, personally, relationally, financially, socially, or spiritually and may include family support, positive relationships and religious faith
Clients often have greater difficulty identifying areas without problems in their life; Train clients to think positively
Strengths are assessed in two ways
--By directly asking about strengths and areas of life that are going well
--By listening carefully for exceptions to problems and for areas of unnoticed strength
Solution Based Contributors
Milton Erickson
Hypnosis
Brief
Strength-based focused
Bill O'Hanlon and Steve de Shazer's Solution-Focused
Steve de Shazer and Insoo Kim Berg
Solution-Focused Brief Therapy
Milwaukee Brief Family Therapy Center
Scott Miller, Barry Duncan and Mark Hubble, Yvonne Dolan, and Linda Metcalf

Solution-Oriented Therapy
Bill O'Hanlon
Michelle Weiner-Davis
Collaborative, Strength-Based Therapy
Matthew Selekman
Overview of Therapy Process (Solution Based Therapy)
Solution-based therapists help clients identify their preferred solution by:
Talking about the problem, exceptions, and DESIRED OUTCOMES
Working with clients to take SMALL ACTIVE STEPS in this general direction each week
This can take 1 - 10 sessions or it may take years depending on the complexity of the case
The Therapeutic Relationship (Solution Based Therapy)
Beginner's Mind
Involves listening to a clients story as if you are listening for the first time not filling in blanks with personal or professional knowledge

Echoing client's key words
Using client language often makes the problem more "solvable" and engenders greater hope

Dual track thinking
Conceptualizing client's words as well as your own reactions (Mastering therapy is making these two things work at the same time; whatever you're thinking and whatever you're hearing that are both going on at the same time)
The Therapeutic Relationship Continued... (Solution Based Therapy)
Carl Rogers with a Twist: Channeling Language
--Reflections of feeling delimit the difficult feeling, behavior or thought by reflecting on a time, context, or relational limit
-Past tense rather than chronic state or characteristic
-Partial rather than global
-Perception rather than unchangeable truth

Optimism and Hope
--Solution-based therapists assume that change is inevitable and that improvement - in some form - is always possible
Case Conceptualization/Assessment (Solution Based Therapy)
Exceptions and "What Works"
Strengths and Resources
Client Motivation: Visitors, Complainant, and Customers
--Visitors: usually brought to therapy by an outside other such as spouse, parents, courts (They don't really want to be there)
--Complainants: identify a problem but expect therapy or some other person to be the primary source of change (The mother that brings her son in and wants you to fix them)
--Customers: identify a problem and want to take action towards the problem
Solution Focused Assumptions
Every client is unique
Clients have the inherent strength and resources to help themselves
Nothing is all negative
There is no such thing as resistance
You cannot change clients; they can only change themselves.
Solution Focused Therapy goes slowly
There is no cause and effect
Solutions do not necessarily have anything to do with the problem.
Emotions are part of every problem and every solution
Change is constant and inevitable; a small change can lead to bigger changes.
One can't change the past so one should concentrate on the future
Goal Setting (Solution Based Therapy)
Goal language - positive, measurable and concrete
Meaningful to client
Interactional
Situational
Small steps
Clear role for client
Realistic
Legal and ethical

Solution-Generating Questions: Miracle, Crystal ball, Magic wand, and Time machine questions work best when therapist:
--Prepares client for a solution-generating question (like training the client to think positively from the beginning)
--Creates a compelling vision
--Asks for behavioral differences
Small steps: Scaling questions for goal setting
One Thing Different: Client-generated change (you can only ask the client to do one thing different)
Interventions (Solution Based Therapy)
Formula First Session Task
--Between now and the next time we meet, I would like you to observe, so that you can describe to me next time, what happens in your family/life/etc that you want to continue to have happen.
Scaling questions for weekly task assignments
--On a scale of 1-10...
Pre-Suppositional questions and assuming future solution
--What will you be doing differently when these issues are resolved?
Interventions Continued... (Solution Based Therapy)
Formula First Session Task
--Between now and the next time we meet, I would like you to observe, so that you can describe to me next time, what happens in your family/life/etc that you want to continue to have happen.

Scaling questions for weekly task assignments
--On a scale of 1-10...

Pre-Suppositional questions and assuming future solution
--What will you be doing differently when these issues are resolved?
Interventions Continued... (Solution Based Therapy)
Coping Questions
--This is so hard - how have you kept it from getting worse?

Exception questions
--Are there times when this doesn't happen?
Miracle, Crystal Ball, Magic Wand, and Time

Machine Questions
--If you go to bed tonight and a miracle happens while you are asleep, and when you wake up in the morning your problem is solved, how will things be different?

Compliments and encouragement
Divorce Busting (Solution Based Therapy)
Michelle Weiner-Davis
Strengths-focused
Present Focused
Small changes lead to larger changes
Idea that it only takes 1 person to change
Specific goals
Identifying patters/behaviors that work and increasing them
Decreasing ineffective patterns and behaviors
Predicting good days
Research/Evidence Base for Solution Based Therapy
Strong, growing evidence base for the model
Three key practical and philosophical challenges of establishing solution-focused

--Difficult to adequately manualize and capture the spirit and epistemological positioning that is essence of the model
--Shallow adherence to techniques without grounding in the theory results in an inaccurate enactment of the therapy
--Certain philosophical principles such as honoring each clients uniqueness and recognizing change processes outside of therapy are at odds with the making global assessments of the effectiveness of this approach
Working with Diverse Populations (Solution Based Therapy)
Widely used with diverse populations in the US, Canada, and internationally

Easily adapted for a wide range of value systems and communication styles

Has been studied with a range of client ethnicities in a wide range of contexts

Approach can be used to identify strengths to access unique emotional, cognitive, and/or social resources inherent within diversity
Experiential Therapies- Three Primary Approaches
The Satir Growth Model
Focus on communication

Symbolic-Experiential
Focuses on symbolic meanings and emotional exchanges

Emotionally-focused Couples Therapy
Leading evidence-based approach to couples therapy
Commonalities of Experiential Theories
Targeting Emotional Transactions
focus on the emotional layer of problematic interactions

Warmth and Empathy

Self of Therapist

Individual and Family Focus
Therapist addresses both individual and family concerns as distinct sets of problems
Virginia Satir Growth Model
Began career in family therapy at the Mental Research Institute (MRI)
Developed her own ideas broadly described as fusing humanistic values into a systemic approach-- aka: she added emotion to the therapeutic approach
One of the first therapists to work with entire families
Focus on individual growth and improving family interactions
Satir's Contributions to the Field
Communication Stances: effective means of conceptualizing communication as each stance recognizes or minimizes three realities: self, other, context
--Congruent: Acknowledge self, other, context
--Placator: Acknowledge other, context; not self (often a people pleaser in a family)
--Blamer: Acknowledge self, context; not other (Victim mentality that blames others)
--Super-reasonable: Acknowledge context, not self or other (someone very in their head; often seen as unrelatable)
--Irrelevant: Tries to avoid acknowledging any (the avoider, the clown of the family)
Satir's Overview of Therapy Process
Uses a six-stage model of change -
1. Status Quo
2. Introduction of Foreign element- (Which is the therapist; or someone gets married, etc.)
3. Chaos (they don't know what to do)
4. Integrating new possibilities
5. Practice
6. New status quo
Satir's Therapeutic Relationship
Humanistic and Systemic Foundations

Therapeutic Presence: Warmth and Humanity- Just be you; dress-wise, personality, etc.

Making Connection

Conveying Hope

Establishing Credibility- letting them know what you're talking about; you might even explain your credentials casually to join with them and also showing them you know what you're doing
Satir's Case Conceptualization/Assessment
Assessment of Family Functioning includes:
--Role of the symptom in the system
--Family dynamics
--Family roles
----------The martyr
-----------The victim
-----------The rescuer
-----------The good/bad child/parent
--Family life fact chronology (TIMELINE- client might just come up with factual things that happened, then in therapy you can explore the emotional components of these events)
--Survival triad
------------Quality of relationship between child, mother, father

Assessment of Individual Functioning includes:
Communication Stances
Self worth / self esteem
Mind / body connection
Satir's Goal Setting
Relationally focused goals:
--Develop ways for all members to communicate congruently

Individually focused goals:
--Promote self actualization of all members
--Emphasis to individual level is unique amongst systemically based therapists
Satir's Interventions
--Self of the therapist (letting the client know they affect you as a person/therapist as well)
--Facilitate emotional expression
--Communication enhancement: Coaching, Role Play, and Enactment
--Sculpting or Spatial Metaphor
--Softening family rules (decreasing family rules)
--Touch
-Virginia Satir Video
Symbolic-Experiential Therapy
Developed by Carl Whitaker
Began in the 1940's as early pioneer in working with families
Shifted from conceptualizing client problems as internal conflicts toward viewing problems as part of dysfunctional interactions
This therapy relies on emotional logic rather than cognitive logic
Focus is on:
The emotional process
Family structure
Balances strong emotional confrontation with warmth and support
Whitaker's Battle for Structure
Battle for Structure
Refers to setting the boundaries and limits for therapy and should be won by the therapist
Specifically refers to:
Ensuring necessary people attend therapy
That therapy occurs frequently enough for progress
Session content /process will produce change
Whitaker's Battle for Initiative
-You should not be working harder than the client

Refers to who has the most investment and initiative to pursue change and should be won by the client
If the therapist has more initiative towards change, clients feel as if they are being "dragged" or "forced"
Greater the clients motivation, the more the process flows smoothly
Whitaker "Therapy of the absurd"
Absurdity is used to perturb the system
Sometimes means speaking a truth
Usually involves playing with otherwise "serious matters"

-Trying to upset the system; sometimes playing around with serious matters
Whitaker's Therapeutic Relationship
Authentic use of self
Personal integrity
Therapist responsibility
Being responsive TO the family without being responsible FOR them
Stimulating mutual growth
Co-therapist
Whitaker Case Conceptualization/Assessment
Authentic Encounters/Affective System
--Focus is primarily on the family's emotional system rather than behavioral interactions
Trial of Labor
--Observing family response to therapist's interventions and interactions
Competency Focus
--Assessment involves emphasis on strengths, competencies, and resources for change
Symptom Development
--Symptoms develop when dysfunctional structures and processes persist over time; symptoms get worse over time
Whitaker Assessing Structural Organization
Permeable boundaries with the families
--Clear boundaries with larger systems
--Role flexibility- ex: Mom wouldn't always have to be happy around the kids
--Flexible alliances and coalitions
--Generation gap
--Gender-role flexibility: Do only the women cook?
--Transgenerational mandates
--"Ghosts"- who is present in the family but no longer living; the influence of someone lasts through generations
Whitaker Assessing Emotional Process
Differentiation and Individuation
Tolerance for conflict
Conflict resolution and problem solving
Sexuality: Is it expressed or not?
Loyalty and commitment
Parental empathy
Playfulness, creativity, and humor
Cultural adaptations
Symbolic process- If someone is late to therapy, what does that symbolize? If only two of the family shows up, what does that symbolize?
Whitaker Goal Setting
Family cohesion
--Increase cohesion to create a sense of nurturance and confidence in problem solving

Developmental tasks
--Promote completion of developmental tasks to promote personal growth

Symbolic world
--Expand the family's symbolic world by expanding their meaning of experience
Whitaker Interventions
--Creating confusion and disorganization
--Here-and-Now experiencing: "So what's it like to see your parents fight like they do?"
--Redefining and expanding symptoms
--Spontaneity, play and "Craziness"
--Separating interpersonal from personal distress
--Affective confrontation of rigid patterns and roles
--Augmenting despair and amplifying deviation (he wanted people to despair on the way to change; he wanted a breaking point)
--Absurd fantasy alternatives (maybe you should move to Africa so your kids won't fight over the car anymore)
--Reinforce parental hierarchy
--Sharing stories, free associations, and metaphors
Emotionally Focused Therapy
--One of the most thoroughly researched approaches in the field, an empirically validated treatment for couples
--Sue Johnson & Les Greenberg developed the model using a combination of
----Attachment theory
----Experiential theory
----System theory
EFT: Softening Emotions
Hallmark EFT technique used to create emotional bonding, change interactional positions, and redefine the relationship as safe and connected

Softening refers to the more critical partner softening his or her stance and words allowing the other partner to reduce their reactivity
EFT Contributors
Susan Johnson with Les Greenberg developed EFT in the 1980's by refining methods based on the outcomes of their research on what worked and what did not
Sue Johnson has continued research on the model and teaches internationally
Les Greenberg has refined a version of the model he calls Emotion-Focused Therapy
EFT: Three primary therapeutic tasks
1. Creation & Maintenance of Alliance
2. Assessing & Formulating Emotion
3. Restructuring Interactions
-----Three stages with nine steps
Stage 1: De-escalation of Negative Cycles (What are they always fighting about)
Stage 2: Change Interactional Patterns
Stage 3: Consolidation and Integration
EFT: The Therapeutic Relationship
Empathetic Attunement
Acceptance
Genuineness
Continuous Monitoring of the Alliance- (Even asking the client after a session or two: Do you think this relationship will work?)
Joining the System
Therapist Role
Expression of Empathy: RISSSC
EFT: RISSSC Conversations
The RISSSC technique is designed to express understanding of the client's affective reality

The technique uses the following steps:
Repeat (example: stopping a talker by looking for their emotions and highlighting those by stopping their detail giving)
Image (giving an image to the emotion someone is giving)
Simple
Slow
Soft
Client's Words
EFT: Case Conceptualization
Intrapsychic and Interpersonal Focus
--Intrapsychic: how individuals process their experiences
--Interpersonal: how partners organize their interactions into patterns and cycles

Attachment and adult love

Primary and secondary emotions (Hurt that is below anger)

Negative interaction cycle
EFT: Interventions
Reflection of emotion (Reflections can help people stop to sit in their emotions)

Validation

Evocative responding: Reflections & Questions

Heightening- Sitting with their feelings

Empathetic Conjecture and Interpretation (If they continue to reject your discernment and you know you're right, you might have to slow down)
EFT: Interventions Continued
Tracking and Reflecting Interaction Patterns

Reframing Problems Contextually (Looking at the system- what is the function of your problem)

Enactments, Restructuring, and Choreography

Turning New Emotional Experience into a New Response to the Partner (Trying to move an emotional connection with you to the other family member)

Self-Disclosure

Sue Johnson on EFT
Collaborative and Narrative Therapies
Most recently developed

Similarities:
--Social constructionist foundations
--Language based
--Possibility focus
--Identity construction

Differences:
--Stance of the therapist
--The role of interventions
--Emphasis on political issues
Collaborative Therapy
Founders
Harlene Anderson and Harry Goolishian developed Collaborative Therapy
Lynn Hoffman as well

Overview
--Two-way dialogical process (walking through something WITH a client)
Explore and co-create new and more useful understandings related to client problems
--Focus on the process of therapy
How ideas are exchanged
--Client's Worldview
Therapist tries to understand the client from within the client's worldview
Not-Knowing and Knowing With (Collaborative Learning)
Collaborative therapists avoid "pre-knowing" also called assuming; just because a counselor works for 40 years doesn't mean they know how the client feels in their situation

Based on a social constructionist epistemology, clients with apparently similar experiences, such as "psychosis," "mania," or "sexual abuse," have unique understandings of their situations

Therapists view the clients knowledge as equally valid with their own
Overview of Collaborative Therapy
Collaborative therapists do not have set stages of therapy or an outline for how to conduct a session

Guiding principle: facilitate generative, two-way dialogical conversations

Key is to avoid monologues which lead to a therapeutic impasse

If this happens, the conversation is gently shifted back to a dialogical exchange of ideas
The Therapeutic Relationship (Collaboration Therapy)
Conversational Partners: "Withness"

Curiosity: The Art of Not Knowing

Client vs. Therapist Expertise

Everyday, Ordinary Language: A Democratic Relationship- The therapist does not talk like a therapist

Inner and Outer Talk (The therapist shares from his/her perspective)
Case Conceptualization (Collaborative Therapy)
Involves two key questions -
1. Who's Talking? Problem-Organizing, Problem Dissolving Systems
Multiple perspectives are collected defining the problem allowing the participants' understanding of the problem to evolve

2. Philosophical Stance: Social Constructionist Viewing
Focus is always on how clients construct meaning about the events in their lives, their worldview. How are you making sense of life right now?
Goal Setting (Collaborative Therapy)
Self-Agency
Increase sense of agency, sense of competence and ability to take meaningful action

Transformation
During therapy, some "original" aspects remain while other aspects are added or diminished

Setting Collaborative Goals
Therapeutic goals included in a treatment plan are constructed collaboratively with clients using everyday language
Interventions (Collaborative Therapy)
Conversational Questions: Understanding from Within the Dialogue

"Appropriately Unusual" Comments

Mutual Puzzling Questions and Process: "Kicking Around" New Meanings

Being Public: Therapists Inner Dialogue

Accessing Multiple Voices in Writing- having a client write a letter to themselves
Reflecting Teams and Reflecting Process (Collaborative Therapy)
Based on the practice where a small team of therapist would observe the therapist talking with families behind a one-way mirror, Tom Anderson and colleagues developed the idea of having the families listen to the team's conversation behind the mirror

The idea is to develop multiple, contradictory perspectives in order that new meanings will be developed with clients
Outside of the Therapy Room (Collaborative Therapy)
Because Collaborative Therapy is more a way of talking and being in the world, the process has been applied to numerous other contexts including:
--Education and Pedagogy
My article!!
--Research
--Business Consultation
Overview of Narrative Therapy
Dominant Discourses
We "story" and create meaning of life events using available dominant discourses - broad social stories, practices, assumptions, and expectations about how we should live

"Problems"
Experienced when a person's personal life does not fit with these societal discourses and expectations

Externalization
Process involves separating the person from the problem
Contributions to the Field (Narrative Therapy)
Understanding Oppression: Dominant vs. Local Discourses

Dominant discourses are culturally generated stories about how life should go

Local Discourses occur in our heads, our closer relationships and marginalized communities

Narrative therapists help clients become aware of how these different discourses are impacting their lives
Overview of the Therapy Process (Narrative Therapy)
Involves finding new ways to view, interact with, and respond to problems by defining the role of the problems in their lives

Broadly involves the following phases:
Meeting the person
Listening
Separating persons from problems
enacting preferred narratives
Solidifying

Process thickens and enriches a person's identity and life accounts
The Therapeutic Relationship (Narrative Therapy)
Meeting the Person Apart from the Problem

Separating People from Problems: The Problem is the Problem

Optimism and Hope

Co-author/Co-editor

Investigative Reporter
--Developing an expose or account of the problem
Case Conceptualization/Assessment (Narrative Therapy)
Problem-saturated stories
--People define themselves by the problems

Unique outcomes and sparkling events

Dominant cultural and gender discourses

Local and alternative discourses: Attending to client language and meaning
Goal Setting (Narrative Therapy)
Narrative Therapy does not include a set of predefined goals - goal setting is unique to each client

Increase the clients sense of agency - the sense that they influence the direction of their lives

Therapist allows the client to take the lead in defining the preferred realities and helps the client reflect on where the idea came from and the effects it will have
Interventions (Narrative Therapy)
--Externalizing: Separating the Problem from the Person
--Metaphors
--Relative Influence Questioning: Mapping Influence of the Problem and Persons
--Externalizing Conversations: The Statement of Position Map
--Externalizing Questions
--Problem Deconstruction: Deconstructive Listening and Questions
--Mapping in Landscapes of Action and Identity/Consciousness
--Intentional vs. Internal State Questions
--Scaffolding Conversations
--Permission Questions
--Situating Comments
--Narrative Reflecting Team Practices
--Re-Membering Conversations
--Leagues
--Definitional Ceremony
--Letters and Certificates
Interventions for Specific Problems (Narrative Therapy)
Children
--Externalization works well with children - particularly the Externalizing Process which adapts well to play and art therapies
--Acting out unique outcomes & preferred narratives often accelerates their adaptation of new behaviors

Domestic Violence
--Jenkins (1990) has developed a Nine-Step Model for working with men who batter which requires the client to take full responsibility for the violence and ending it
Working with Diverse Populations
Ideal for marginalized populations, approaches focus on how the client's problems relate to the broader socio-political context

The local discourse focus of Collaborative therapy ensures that the client's cultural values and beliefs are central to the therapy process

Both Narrative and Collaborative Therapy have international roots and are practiced in numerous countries around the world