Family & Group Therapies Flashcards
Roots of family therapy
- general systems and cybernetic theory
General systems theory
- originally used by biologists
- used to describe the functioning of living & non-living systems
- All systems consist of interacting components, our governed by the same general rules and have homeostatic mechanisms that help maintain equilibrium and stability
Cybernetic theory
- concerned with mechanisms that regulate a system’s functioning
- distinguishes between negative and positive feedback loops
Negative feedback loops
- cybernetics
- resist change and help a system maintain the status quo
Positive feedback loops
- cybernetics
- amplify change and disrupt the status quo
Double blind communication
- linked to the development of schizophrenia
- when you receive two contradictory messages from a family member and are not allowed to comment on the contradiction
Symmetrical interactions
-bateson
- equality
- behavior one person elicited to similar type of behavior from the other person
- can escalate in intensity or become one-upmanship
Complementary interactions
Bateson
- inequality
- behavior one person compliments behavior of another
- one dominant role, one subordinate role
Recent approaches to family therapy
- influenced by postmodernism and challenge were the basic premises of general systems theory
-have a constructurist/ social constructivist perspective
- assume there are multiple view points and realities
- It’s a shared process, therapist worms are collaborative relationship with family and helps family members identify alternative ways to interpreting and solving problems
APA guidelines for classifying evidence-based treatment in couple and family therapy
- best treatments are based on both science and the accumulative knowledge of experienced practitioners in order to accurately identify both the efficacy and utility of clinical procedure
Three levels of evidence
Level 1 couple and family therapies
- evidence informed interventions that are supported by a pre-existing research or linked to evidence-based treatment models
- have not been empirically evaluated themselves or have not been evaluated for specific populations or problems
- gottman’s marital therapy
- structural family therapy
Level 2 couple and family therapies
- promising interventions that have preliminary evidence for their effectiveness but have not been replicated for specific populations or problems
- inside oriented marital therapy
- attachment-based family therapy
Level 3 couples and family therapies
- evidence-based interventions that are supported by systematic high quality research
- shown to be effective but have not been replicated for specific populations or problems
Divided into four categories
Category 1 (couple & family therapies)
- level three
- there is evidence of an intervention’s efficacy and effectiveness when compared to no treatment (absolute efficacy)
- all interventions and level 3 must at minimum meet this criteria
- brief structural family therapy
- integrative behavioral couple therapy
Category 2 (couple & family therapies)
- level three
- there’s evidence of the interventions, efficacy and effectiveness compared to alternative treatments (relative efficacy)
- behavioral marital therapy
- parent management training
Category 3 (couple & family therapies)
- level three
- there’s evidence of efficacy and effectiveness of an interventions model specific change mechanism (verified mechanism of action)
- behavioral couples therapy
- family psycho psycho education interventions for schizophrenia
Category 4 (couples and families)
- level three
- evidence that intervention has beneficial outcomes for specific client populations, for specific clinical problems, and for different service delivery systems (contextual efficacy)
- multi-systemic therapy for adolescent problem behaviors
- behavioral couples therapy for alcohol and substance use disorders
Extended family systems therapy
- Bowen
- aka intergenerational or transgenerational family therapy
- derived from his work with children with schizophrenia and their families
- transmission of certain emotional processes from one generation to the next is responsible for the development of schizophrenia and a family member
Differentiation (Bowen)
- intra and interpersonal
- intrapersonal= person’s ability to distinguish between their own feelings and thoughts
- interpersonal=makes it possible for a person to separate their own emotional and intellectual functioning from that others
Emotionally fused
- Bowen
- caused by low level of differentiation
Emotional triangles (Bowen)
- when a family dyad experiences tension , it may recruit a third family member in order to help alleviate tension and increase stability
Ex. Husband and wife may reduce conflict by becoming over involved with one of their kids
- likely hit an emotional triangle with develop increases as a levels of differentiation and family members decrease
Family projection process (Bowen)
- parents projection of their emotional immaturity onto their children which results in children having lower levels of differentiation
Multi-generational transmission process
- Bowen
- transmission of emotional maturity from one generation to the next
- occurs. When the child most involved in the family’s emotional system becomes the least differentiated family member and as an adult chooses a partner who has similar levels of differentiation.
- This leads to the transmission of a lower level of differentiation tooth, one of their children and eventually results in the development of severe symptoms in a child
Increasing differentiation
- Bowen
-increased differentiation and one family member will facilitate greater differentiation in other family members
Extended family systems therapy therapists
- often only see two family members in therapy
- usually the parents or individual family members most capable of increasing their level of differentiation
Primary goal of EFST
- increase each family members differentiation
Strategies for increasing differentiation (EFST)
- therapy begins with the assessment, which includes a genogram to depict family relationships and important life events for at least three generations and is used to help family members understand intergenerational patterns of functioning
- therapist will then ask questions that are designed to diffuse emotions and help family members identify how they contribute to family problems
- family members are taught how to interact with families of origin and ways that alter triangulated relationships
Role of therapist in EFST
- coach
- stay connected with family members but remain neutral and avoid becoming involved in families emotional processes
- family members talk directly to therapist rather than each other to reduce emotional reactivity
Structural family therapy
Minuchin
- based on the assumptions that family members symptoms are related to problems in the family structure
- identifies subsystems and boundaries as important aspects of family structure
Subsystems (structural family therapy)
- smaller units of the entire family system that are responsible for carrying out specific tasks
- example, parental subsystem: family members responsible for caring for children
Boundaries (sft)
- different degrees of permeability
- exist on a continuum
Overly diffuse boundaries (SFT)
- lead to and meshed relationships
Overly rigid boundaries (SFT)
- lead to disengaged relationships
Clear boundaries (SFT)
- allow family members to have close relationships while maintaining a sense of personal identity
4 rigid family triads (SFT)
- family problems which help parents obscure or deny conflicts
- stable coalition
unstable coalition - detouring – attack coalition
- detering – support coalition
Stable coalition( SFT )
- one parent and a child form a flexible alliance against the other parent
Unstable coalition (SFT)
- triangulation
- each parent demands the child side with them
Detouring – attack coalition. (SFT)
- parents avoid the conflict between them by blaming the child for their problems
Detouring – support coalition (SFT)
- parents avoid their own conflict by overprotecting the child
Maladaptive behaviors according to SFT
- due to dysfunctional family structure that causes family to repeatedly respond inappropriately to developmental and situational stress
Primary goals of SFT
- to alleviate current problem
-change family structure by altering coalitions and creating clear boundaries
Three overlapping phases of SFT
- therapy focuses on promoting behavioral change
- joining
- evaluating
- intervening
Joining( SFT)
- establishes a therapeutic alliances
- memesis
- tracking
-mainteance
Memesis (SFT)
- therapist adopts the families affective, behavioral, and communication style
Strategic family therapy
- Haley
- assumes that struggles for power and control in relationships are core features of family functioning
Symptoms according to strategic family therapy
a symptom is a strategy that is adaptive to current social situation for controlling a relationship with all strategies have failed
Power and control according to strategic family therapy
- determined primarily by hierarchies within the family
- maladaptive family functioning is often related to unclear or inappropriate hierarchies
Primary goal of strategic family therapy
- ultra family interactions that are maintaining its symptoms
Strategic family therapy interventions
- therapist assumes an active role and uses a variety of strategies aimed at changing behaviors rather than instilling insight
Initial session of strategic family therapy
- highly structured and consists of four stages
- brief social stage
- problem stage
- interactional stage
-goal setting stage
Social stage strategic family therapy
- therapist welcomes the family and observes family interactions
Problem stage strategic family therapy
- therapist elicits each family members view of the family problem and it’s causes
Interactional stage strategic family therapy
- family members discuss their different views of the family’s problems and the therapist observes how family members interact when addressing the problem
Goal setting stage strategic family therapy
- therapist helps family members agree on definitions of the family’s problems and concrete therapy goals that target the problem
Subsequent sessions of strategic family therapy
- therapist uses the combination of straightforward and paradoxical directives
Straightforward directives
- instructions given to engage in specific behaviors. That will change how the family members interact
Paradoxial directives
- help family members realize that they have control over problematic behaviors or use their resistance of family members to help them change in the desired way
Examples of paradoxial directives
- prescribing the symptom
- restraining and ordeals
Prescribing the symptom
- involves instructing family members to engage in the problematic behavior often in an exaggerated way
Restraining
Encouraging family members not to change or warning them not to change too quickly
Ordeal
- unpleasant task that a family member is asked to perform whenever they engage in an undesirable behavior
Milan systemic family therapy
- based on the assumption that family as a whole protects itself from change through homostatic roles and patterns of communication
Patterns of communication in Milan systemic family therapy
- referred to as family games
Family games associated with problematic behaviors
- are rigid, involve power struggles between family members, and are known as dirty games TV show
Leading contributors to systemic family therapy
-Salvini-Palazzoli
-Boscolo
-Ceechin
-Prata
Primary goal of strategic family therapy
- Al only rules and communication patterns that are maintaining problematic behavior
Interventions of Milan systemic family therapy
- providing family with information that challenges family games and helps family members develop communication patterns and increase the family’s ability to adapt change
Distinguishing attributes of Milan systemic family therapy
- use of a therapeutic team
- five part therapy session
- gaps between each session of 4 to 6 weeks
Five part therapy sessions of Milan systemic family therapy
- pre-session
- session
- inter-session
- intervention
- post session
Strategies of Milan systemic family therapy
- hypothesizing
- neutrality
- circular questioning
- positive connotation
- family rituals
Hypothesizing
- continual interactive process of speculating and making assumptions about the family situation
First hypotheses Milan systemic family therapy
- based on information, obtained an initial phone interview and are modified during therapy as new information about the family functioning is acquired
Neutrality
- the therapist interest in the family situation and acceptance of each family members perception of the problem
Circular questioning
- asking each family member the same question to identify the differences and perception about events and relationships
- also used to uncover communication patterns within the family
Family rituals
- activities that are carried out by family members between sessions
- designed to alter problematic family games
Positive connotation
- reframing that helps family members view symptoms as beneficial because they maintain families, cohesion and well-being
- the purpose is to change family’s perception of a symptom from an individual family member’s illness to a behavior that is voluntary, controlled and well intentioned and involves the entire family system
Conjoined family therapy
-Satir
- also known as human validation process model
- influenced by humanistic psychology and communication and experiential approaches to family therapy
Theory of conjoint family therapy
- family system seek a state of balance
- family problems arise when balance is maintained by unrealistic expectations, inappropriate rules and roles, and dysfunctional communication
Four types of dysfunctional communication according to conjoint family therapy
- placating
- blaming
- computing
- distracting
Placating communication style (CFT)
- a green or a capitulating to others due to fear, dependency, and a desire to be loved and accepted
Blaming communication style. (CFT)
- accusing, judging, and bullying others boy taking responsibility and hide feelings of vulnerability and worthlessness
Computing communication style (CFT)
- taking an overly intellectual and rational approach to avoid becoming emotionally engaged with others
Distracting communication style (CFT)
- changing the subject and making a inappropriate jokes to distract attention and avoid conflict
Congruent communication (CFT)
- leveling style
- functional style that is characterized by congruence between verbal and non-verbal messages, directness and authenticity and emotional engagement with others
Primary goal of conjoint family therapy
- enhance the growth potential of family members by increasing their self-esteem, strengthening problem solving skills, and helping them communicate congruently
Therapist role in CFT
- therapist use of self is the most important therapeutic tool
- therapist has multiple roles when working with clients including facilitator, mediator, advocate, educator, and role model
Therapeutic interventions used in conjoint family therapy
- family sculpting
- family reconstruction
Family sculpting (CFT)
- involves having each family member take a turn positioning other family members and ways of depict their views of family relationships
Family reconstruction. (CFT)
- psychodrama that involves role playing three generations of family to explore unresolved family issues and events
Narrative family therapy
- Epson and White
- person’s problems arise from and are maintained by oppressive stories which dominate the person’s life
- the stories are social constructed
- The problem is not the person. The problem is the problem, I eat it exists outside the person
Primary goal of narrative family therapy
- replace problem saturated stories with alternative stories that support are more satisfying and preferred outcome
Process of therapy of narrative family therapy
- meeting family members
- listening
- separating family members from their problems
- enacting
- solidifying
Meeting family members (narrative family therapy)
- getting to know family members separate from their problems by asking about their interest in everyday activities
Listening( narrative family therapy)
- paying attention to what family members say to identify dominant, discourses and unique outcomes
Unique outcomes ( narrative family therapy)
- experiences that are not consistent with the problem. Saturated story
Separating family members from their problems. (Narrative family therapy)
- externalizing the problems
