04_Family Therapies Flashcards
General Systems Theory
Interacting components are best understood by studying them in their context
General Systems Theory:
Family as Open System
Receives input from environment
Discharges output to environment
Adaptable to change
Seeks HOMEOSTASIS
Homeostasis
Tendency for family to act in ways that maintain equilibrium / status quo
Consequence of Homeostasis
If the problems of one family member improve, the disturbance is likely to reappear elsewhere in the family
Family Therapy:
Main influences
General Systems Theory (Bertalanaffy 1968)
Cybernetics (1940’s)
Cybernetics
Originally developed by mathematician, subsequently applied to family education processes
Main Feature = FEEDBACK LOOP
Negative Feedback Loop
Reduces deviation
Helps the system maintain status quo
Positive Feedback Loop
Amplifies deviation or change
Disrupts the system, can lead to breakdowns “runaways”
*Can promote appropriate change in In some situations
Family Therapies: Characteristics
Reciprocal view of causality
Relational
Focuses on the Here-and-Now
Emphasizes freedom of choice
Contextual, relativistic perspective
Earliest contributors to family therapy
Ackerman, Bateson, Bowan
“Don’t be A BaBy!”
a-b-b
Nathan Ackerman
“Grandfather of family therapy”
Integration of psychoanalysis with systems approach
Saw family members together in therapy
Double-Bind Communication:
Who and What
Bateson
Schizophrenia due to contradictory “don’t” statements
Recipient is not allowed to comment or seek help from someone else
Bowen and theory of Schizophrenia
Development of Schizophrenia is due to repetition of certain family interactions over three generations
Communication/Interaction Approach:
3 Main Assumptions
All behavior is communication
(even when “doing nothing”)
All communication has a “report” and a “command” function
Communication/ interaction patterns are either symmetrical or complementary
Communication/Interaction Family Therapy:
“report” function
Content/informational aspect of communication
Communication/Interaction Family Therapy:
“command” function
Nonverbal
Makes a statement about the relationship between communicators
*Problems arise when report command functions are contradictory
Communication/Interaction Family Therapy:
Symmetrical communication
Reflects equality between communicators
May escalate into competitive “one-upsmanship”
Communication/Interaction Family Therapy:
Complementary communication
Reflects inequality and maximize differences between communicators
Results in dominant and submissive roles
Communication/Interaction Family Therapy:
View of Maladaptive Behavior
Circular causality
Symptom is both a cause and effect of dysfunctional communication patterns
E.g. blaming and criticizing, mind reading, overgeneralizing
Bowen’s Extended Family Systems Therapy:
Three Key Terms
Differentiation
Emotional triangle
Family projection process
“extend bow and arrow”
(Bowen, bow and)
Extended Family Systems Therapy (Bowen):
Differentiation (of Self)
Ability to separate one’s intellectual and emotional functioning
Low differentiation = more emotion mind = become fused with emotions that dominate the family
Extended Family Systems Therapy:
Undifferentiated Family Ego Mass
Low differentiation throughout family
Family members are highly emotionally fused
Extended Family Systems Therapy:
Emotional Triangle
When husband-wife or parent-child recruit third person to reduce tension / increase stability
Lower differentiation = higher likelihood of emotional triangle
Extended Family Systems Therapy:
Family Projection Process
Parental conflicts and emotional immaturity are transmitted to children
Results in child having lower level differentiation than parents
Extended Family Systems Therapy:
View of maladaptive behavior
- Multi-generational transmission process*
Progressively lower levels of differentiation are transmitted from one generation to the next
Extended Family Systems Therapy:
Therapy Goals
Primary goal is to increase differentiation of all family members
Extended Family Systems Therapy:
Therapy Techniques
Usually includes only spouses
Therapist becomes third member in therapeutic triangle
Therapist presence reduces fusion and helps them to achieve higher differentiation
Extended Family Systems Therapy:
Genogram Graphic Depictions
Relationships between family members
Dates of significant life events
Any other relevant/important info
Extended Family Systems Therapy:
Role of therapist
Active expert/coach who helps each partner achieve greater differentiation
Key technique is questioning
Minuchin’s Structural Family Therapy: Main Concepts
Power hierarchies
Boundaries
Rigid Triads
Enmeshment
Bowen and mate selection
Bowen believed that people choose mates with similar differentiation levels
Extended Family Systems Therapy (Bowen):
Family Projection Process: Most affected child
Usually one of the following:
Oldest child
Child born during period of family stress
Child perceived to be “special”
Extended Family Systems Therapy (Bowen):
Rationale for only working with one family member
Work with family member with most differentiation
Goal is to reduce their influence on other members
Extended Family Systems Therapy (Bowen):
Therapeutic Communication
Partners are encouraged to:
Talk to the therapist rather than to each other
Speak in a calm, factual manner
Minuchin’s Structural Family Therapy:
Boundaries
Barriers or rules that determine the amount of contact allowed between family members
Minuchin’s Structural Family Therapy:
Result of Rigid Boundaries
Disengagement / isolation
Minuchin’s Structural Family Therapy:
Result of Diffuse/ Permeable Boundaries
Enmeshment = overly dependent / close relationships
Minuchin’s Three Rigid Triads
aka, Chronic boundary problems
Detouring
Stable Coalition
Triangulation
Minuchin’s Structural Family Therapy:
Detouring
Parents direct focus on child by either:
overprotecting
blaming (scapegoating) child for family’s problems
Minuchin’s Structural Family Therapy:
Stable Coalition
Parent and child gang up against the other parent
Minuchin’s Structural Family Therapy:
Triangulation
Each parent demands that the child side with them against the other parent
a.k.a. “Unstable coalition”
Minuchin’s Structural Family Therapy:
View of Maladaptive Behavior
Inflexible family structure prohibits healthy adaptation to maturation and situational stressors
Minuchin’s Structural Family Therapy:
“Psychosomatic Families”
Child’s symptoms (e.g. diabetes, anorexia) help diffuse conflict by diverting attention away from it
Minuchin’s Structural Family Therapy:
Therapy Goals
Restructuring the family = primary long-term goal
Minuchin’s Structural Family Therapy:
Therapy Techniques
Three overlapping steps:
Joining
Evaluating the Family Structure
Restructuring the Family
Minuchin’s Structural Family Therapy:
Theoretical Approach
Action precedes understanding
Here and now, directive, concrete approach
Emphasis on changing behaviors rather than fostering insight
Minuchin’s Structural Family Therapy:
Joining
Therapist develops therapeutic system by joining family in position of leadership and blending
Tracking: identifying family’s values, themes, life events
Mimesis: adopting family’s affective and communication style
Minuchin’s Structural Family Therapy:
Evaluating the Family Structure
Once therapist has joined the family, they develop a structural diagnosis and treatment goals based on:
Transactional patterns (develop a structural map)
Power hierarchies
Boundaries
Minuchin’s Structural Family Therapy:
Restructuring the Family
A variety of techniques are used to deliberately unbalance (stress) homeostasis in order to facilitate transformation of family structure:
Enactment
Reframing
Minuchin’s Structural Family Therapy:
Enactment
Restructuring technique
Family members role-play relationship patterns
Patterns are identified and altered
Minuchin’s Structural Family Therapy:
Reframing
Restructuring technique:
Relabeling behaviors so they can be viewed in more positive ways
Minuchin’s Structural Family Therapy:
“Psychosomatic Families”: Three Characteristics
High enmeshment that limits autonomy
Low tolerance for conflict
Overprotectiveness
Haley’s Strategic Family Therapy: Influences
Communication/Interaction and Structural Family therapies
Milton Erickson: Hypnosis to increase ability to manipulate client and control course of therapy
Haley’s Strategic Family Therapy:
Paradoxical Directives
Techniques that use client’s resistance to change their behavior
Haley’s Strategic Family Therapy:
View of Maladaptive Behavior
Communication is used to exert control
Symptom = strategy for controlling relationship when all other strategies have failed
Pathological struggle for control = when one or both parties denies the intent to control the other person
Haley’s Strategic Family Therapy:
Therapy Goals
Alleviate symptoms by altering transactions and hierarchical organization
Behavior change results in changes in perception and emotions
Haley’s Strategic Family Therapy:
Four Stages of Therapy
Social stage
Problem stage
Interaction stage
Goal-setting stage
“Haley wants some water, turn on the SPIGot”
Haley’s Strategic Family Therapy:
Therapy Techniques
Therapist has and active, “take-charge” role
Therapist issues directives/assignments to be performed outside of therapy
Directive can be straightforward or paradoxical
Haley’s Strategic Family Therapy:
Paradoxical Interventions
Alters behavior of family by:
Helping them see symptom in an alternative way
Using their resistance in a constructive way
Haley’s Strategic Family Therapy:
Five Paradoxical Interventions
Ordeals
Restraining
Positioning
Reframing
Prescribing the Symptom
Haley’s Strategic Family Therapy:
Ordeals
Unpleasant tasks that client must perform whenever a symptom occurs
Haley’s Strategic Family Therapy:
Restraining
Encouraging the family not to change
Haley’s Strategic Family Therapy:
Positioning
Exaggerating the severity of a symptom
Haley’s Strategic Family Therapy:
Reframing
Relabeling a symptom to give it a more positive meaning
Haley’s Strategic Family Therapy:
Prescribing the Symptom
Instructing a family member to deliberately engage in the symptom
Milan Systemic Family Therapy: Origins
Mara Selvini-Palazzoli, child psychoanalyst
She altered her therapy techniques when she found a family systems approach to be more effective for treating children with Anorexia Nervosa
Milan Systemic Family Therapy:
View of Maladaptive Behavior
Family system contains circular patterns of action and reaction
Pathology: Patterns become so fixed that family members are no longer able to act creatively or make new choices about their lives
Milan Systemic Family Therapy:
Therapy Goals
Elucidate choices and assist family members in exercising their prerogative of choosing
Milan Systemic Family Therapy:
Therapeutic Team
One or two members meet with family during sessions
Remaining team members observe sessions behind a one-way mirror
Milan Systemic Family Therapy:
Strategy Conference
When one observer calls a therapist out of the session to share observations and make suggestions
Milan Systemic Family Therapy:
Four Therapy Techniques
Hypothesizing
Neutrality
Paradox
Circular Questions
Milan Systemic Family Therapy:
Paradoxical Strategies
Used to provide family members with helpful information (Not to elicit resistance)
Counter paradox = therapeutic double bind
Positive Connotation = reframing
Milan Systemic Family Therapy:
Circular Questions
Questions that are asked of each family member to help them recognize differences and similarities and perceptions
E.g. “Who was more upset, mom or dad?”
*Implementation of question is circular–go around the room and ask everyone (question itself is not circular)
Behavioral Family Therapy: Overview
Operant conditioning
Social learning theory
Social exchange theory
Behavioral Family Therapy: subtypes
Behavioral marital therapy
Parent training
Conjoint sex therapy
Behavioral Family Therapy:
View of Maladaptive Behavior
All behavior is learned and maintained by its antecedents and consequences
Behavioral Family Therapy:
Therapy Goal
Alter environmental factors that are maintaining problematic behaviors
Behavioral Family Therapy:
Therapy Techniques
Focus on observable behaviors
Ongoing treatment formulation / target identification
Contingent reinforcement
Behavioral Marital Therapy:
Stuart (1969) Operant Interpersonal Therapy
Contingency contracts used to increase positive reinforcements exchanged by partners
Object Relations Family Therapy:
View of Maladaptive Behavior
Unresolved intrapsychic conflicts in the family-of-origin are replicated in current relationships
Object Relations Family Therapy:
Projective Identification
Dysfunction which occurs when a family member reacts to other member as through they actually possess projected characteristics
*Or provokes that person to act in ways consistent with those characteristics
Object Relations Family Therapy:
Primary Therapy Goal
Resolve each family member’s attachment to family introjects
Object Relations Family Therapy:
Therapy Techniques
Interpretation of transferences, resistances, and other factors in order to foster insight
Recognition and addressing of Multiple Transferences
Object Relations Family Therapy:
Multiple Transferences
Transferences of :
One family member to another
Each member to the therapist
Family as a whole to the therapist
Double-Bind Communication Example
“DO that and you’ll be punished”
“DON’T do that and you’ll be punished”
One is expressed verbally
One is expressed nonverbally
Double-Bind Communication:
Mnemonic
Bateson / Bateman
“Arrested Development of schizophrenia”
(Jason Bateman)
double-bind
Picture GOB tying him up for magic trick
