Couple and family therapy Flashcards
What is the difference between first and second order cybernetics?
First order cybernetics:
- The therapist is an independent observer who views the problems separately to the family.
- There is an objective perception of behaviour, interactional patterns and dysfunctional structures.
- Change is through influencing not understanding, therapist is directive
- Focus of change is on behaviour rather than thoughts/feelings
- As the therapist’s views are not influenced by past history and clouded with emotion, it can provide a realistic insight into the problems.
- This can be superficial and not a holistic way of treating the family, as the therapist doesn’t seek information from all members to get to the root of the problem.
- Therapist is authoritarian (considered the expert), client can be passive
Second order cybernetics:
- There is no single correct way of looking at the problem, as people have valid observations of reality.
- Therapist promotes change through conversation and co-construction of meaning
What are the first order cybernetic approaches to family therapy?
- Structural FT
- Strategic FT
- Milan systemic therapy
What are the second order cybernetic approaches to family therapy?
- Post-Milan systemic FT
- Brief Solution-focused therapy
- Narrative therapy
- Collaborative therapies
- Evidence-base
What is structural family therapy (Minuchin)?
The idea that problems stem from dysfunctional family structures - parents at top of hierarchy, children below them.
E.g. enmeshment (parent closer to child than to spouse), disengagement (distant parent), triangulation (parent communicates to spouse through child)
The therapy helps family adapt to changes and stressors in a healthy way.
- Therapist observes patterns
- Applied to conduct problems, psychosomatic problems, anorexia nervosa
What is strategic family therapy (Haley, Madanes)?
Emphasises poor patterns of communication and incorrect problem solving. They do not solve problems with different strategies.
What is Milan Systemic Family Therapy (Pallazoli, Cecchin, Boscolo, Prata, Hoffman)?
Problems come from having no clear boundaries between hierarchical levels. Focuses on power struggles, games, members try to benefit from dysfunctional behaviour.
Therapist is neutral towards everyone.
Circular view: A causes B causes A not linear: A causes B - behaviour of one person has an effect on others
What is Post-Milan Systemic Family Therapy?
Therapist only asks questions, doesn’t give advice. Ask questions with curiosity to expand the member’s beliefs beyond their existing ones.
Influenced by social constructionism - reality is constructed between therapist and family.
Therapist is neutral but cannot be in cases of child abuse, domestic violence (feminist view).
What is Brief solution-focused therapy?
Focuses on solutions, looks to the future and not problems of the past. Family have the capacity to work towards solutions. Focus on times when the family had no problems “Are there times when this has been less of a problem?” or “What did you (or others) do that was helpful?”
What is Narrative therapy?
Clients have a problem-saturated narrative of their lives and therapy helps them to deconstruct stories to find their preferred narrative. Client is the expert, therapist guides. They re-author their life story.
No universal truth. Roles are socially constructed - certain thoughts, events given meaning. There are different lenses to understand the problem; narratives are influenced by cultural norms, social beliefs and aim is to find examples that contradict them to rewrite the story.
What are collaborative therapies?
The therapist listens and uses the process of “not-knowing” and opens up space for new meaning through dialogic conversation (responses are influenced by previous responses and reactions from others). The therapist moves between knowing and not-knowing, hypothesises based on new information received from the family.
What is Open dialogue?
Developing a network of people (family, friends) around a patient so they have a community of care. It reduces the role of the therapist. Everyone is equally dominant. Allows the patient to share their experience.
What are the core principles of couple therapy?
- Alter the view of the relationship - objective, not blaming. A functional analysis reframes relational conflict as a negative interaction where people try to meet needs for closeness, intimacy, attachment security but fail.
- Decrease dysfunctional interactional behaviour - neutrality should be abandoned in favour of safety for DV, issues such as gambling need immediate attention. Change aggressive behaviours.
- Elicit avoided private behaviour - promote self-disclosure, break patterns and prevent avoidance, repair past attachment injuries
- Improve communication - training, role-playing, specific rules
- Promote strengths - include stories of how the couple met each other, give tasks, pleasant events
