ecosystemic structural family therapy Flashcards
notes from minuchin about structural family therapy and what needs to happen to it at his final lecture
-More History (glasses used to see your world)
-True Joining
-Engaging children in solutions
-Less direct confrontation, seduce the family toward change, rather then push them there
what are the three primary elaborations of ecosystemic structural family therapy (pieces added to structural family therapy)
- A move away from “here and now” interactional focus. Increased data to include: biological, developmental and affective process.
- The posture between therapist and client moved to a more collaborative partnership.
- Emotions and the emotional development of the family became a focus. In particular, attention was given to family styles of regulating and soothing strong affective states, including emotional attachment (attachment).
-current goals of ESFT
-Resolve presenting problems, eliminate negative cycles
-Shift developmental trajectory toward greater self-regulation and social-emotional competence
-Family is assisted in organizing and emotionally connecting to become growth-promoting
-Utilize community systems to move family toward a growth promoting context
four interrelated constructs of ESFT
Family structure
Family emotional regulation
Individual differences
Family development
-The forces that support or constrain a child’s movement toward emotional competence.
explain affective proximity
Not just “involvement” with each other, but rather, it is looking at the creation of emotional security
-Monitor one’s own and other’s emotions and feelings
-Discriminate between various emotional states and evaluate intensity
-The ability to sooth oneself, in the middle of strong affect
-The ability to truly empathize
evolution of structural family therapy
-Structural family therapy was the most popular, developed as one of the types of therapy that is validated, and many of the other therapies that came after structural were based off of structural therapy
-Field moved to things not being strict evidence based practice
overarching goal of ESFT
create a context within the family system that fosters greater relationship stability and greater emotion regulation.
When therapists are successful, the child referred for treatment shows significantly reduced symptoms of distress, they are no longer a safety concern, and they are better able to handle the typical demands of participating in home, school and the community.
explain reducing placements
Most importantly, caregivers come to believe they can manage and parent their children in their home. They are no longer talking about out-of-home placement.
-Trying to reduce people being placed in inpatient areas, usually when people go into these places they do not get much change, they get stabilized
-Led to the increase of in-home treatments and intensive outpatient
core patterns that lead to dysregulation
If you can address these four areas you will stabilize families.
-Wounded caregiver who is emotionally reactive
-Wounded child who is emotionally reactive
-Low support for caregiving functions
-Weak executive role in families
-These things lead to insecure child-caregiver attachments which then lead to chronic, severe emotional disturbances
cornerstones of ESFT
1) strengthen the co-caregiver alliance
2) strengthen the caregivers’ emotional availability to the child,
3) strengthen the caregivers’ leadership role in the family, and
4) build support for the caregivers and the child in the extended family and community
-People tend to like to feel like they are helpful
explain how the mechanisms of change in ESFT relate to other interventions
In ESFT, there are six conditions (i.e., mechanisms of change) that, when present, are assumed to account for positive and meaningful change in fragile families with a child who has SED. Although the particular way in which these mechanisms are operationalized is specific to ESFT, they reflect common factors found in all current evidence-based family intervention models (Sprinkle & Blow, 2004).
what are the 6 mechanisms of change
1) All family members who can influence the functioning of the child and the caregivers and their relationship with one another are included in treatment
2) A strong therapeutic alliance is established between therapists and all family members
3) Family members experience themselves as being part of a respectful, collaborative, and accountable relationship with therapists
4) Family members experience themselves as safe, calm, regulated, and emotionally connected with one another in the presence of the therapists
5) Negative, judgmental behavioral views of the child and one another are moving in the direction of a more compassionate, relational one
6) Family members experience themselves as successfully practicing new, more functional patterns with one another.
what are some helpful strategies with fragile families
-Understanding which families constitute this label is crucial. These families have significant troubles both economically and relationally. Little is secure in these homes, so even the slightest “bump in the road” can become a major crisis. Thus, clinicians need to address multiple areas of the family at the same time.
-Multiple approaches must be offered simultaneously. Parent education, service coordination, crisis intervention, family support, and case management are all necessary. Without some type of team, these families are simply too chaotic to benefit fully from typical family therapy.
-Communication is challenging under this pressure. Communication is difficult in these homes because the pressure to find money, keep shelter and avoid negative interactions with the outside society makes the home an emotional pressure cooker. The clinician must be aware of how to lessen the emotional arousal while increasing familial support.
-Strengthen the co-caregiver alliance. The primary parents must experience some sense of being able to work together and help each other. Assignments and clear discussions are often necessary.
-The emotional connection between the parent(s) and each child must be improved. This relationship is inherently satisfying, so the clinician should continue to assert that this relationship can be made more emotionally satisfying for each party.
-Supports outside the family must be increased. These families need to have more stability, and healthy community involvement will invariably increase stability. There are people to offer some assistance, and following this support these “fragile families” become contributors to the community again.
overall lessons of fragile families
-Shift your expectation of how much buy in to expect
-Connecting with everyone is possible but needs to be done carefully
-Learn how to shift away from conflict by still linking people
-Bring in others
-Consider the advantages of being part of a team
-Emotional explosions must be lessened
