Family Therapies

Question 1

General Systems Theory

Answer 1

GST (Ludwig von Bertalanffy): system as an entity that is maintanined by the mutual interactions of its components and assumes that the actions of the interacting components are best understood by studying them in context.

1. Open System: the family, continuously receives input from and discharges output to the enviornment and is more adaptable to change.
2. Homeostatsis: tendency for a family to act in ways that maintain the family’s equilibrium.
   
   1. as one member improve, the distrubance is likely to reappear elsewhere in the family.

Question 2

Cybernetics

Answer 2

Cybernetics: feedback loop therough which a system receives information

• Negative feedback loop: reduces deviation and helps a system maintain status quo
• Positive feedback loop: amplifies deviation or change and thereby disrupts the system. Can be good in the therapy to drive change.

GST and Cybernetics: Kantian (non-western, Locke) focus on reciprocal view of causality.

here-and-now, relational, freedom of choice, contextual, relativistic (not deterministic).

Ackerman: grandfather of family therapy, psychoanalysis and systems theory to see family all together in therapy.

Bateson: double-bind communication: catch-22, either way you are punished. stuck!

Bowen: research with families with schizophrenic child.

Question 3

1.0

Communication/Interaction Family Therapy

Answer 3

Communication/Interaction Family Therapy

Mental Research Institute (MRI) of Palo Alto

Jackson, Satir, Riskin, Haley

1. specific communication styles affect family interactions and relationships
2. all behavior is communication, we are always communicating.
3. all communication has a ‘report’ and a ‘command’ function
4. Report Function: content/informational aspect of communication
5. Command Function: conveyed nonverbally and makes a statement about the relationship between communicators
6. Symmetrical Communications: equality between communicators but may escalate into a competitive ‘one-upsmanship’ game where each person tries to outdo the other.
7. Complementary Communications: reflect inequality and maximize differences between communicators (dominant vs. submissive).

Circular model of causality that regards symptoms as both cause and effect of dysfunctional communication patterns, which include blaming, criticizing, mindreading, and overgeneralizing.

GOAL: alter interactional patterns that maintain present symptoms.

• direct techniques (id problems as they happen) and
• paradoxical strategies such as
  
  • prescribing symptoms and
  • reframing.

Question 4

2.0

Extended Family Systems Therapy

Bowen

Answer 4

Bowen’s Extended Family Systems Therapy

took general systems theory beyond the nuclear family to the extended family

1. Differentiation of Self: person’s ability to separate their intellectual and emotional functioning. Lower differentiation the more they are at mercy of their emotions and fused with the emotions dominant in the family. Do not want to be undifferentiated family ego mass: highly emotionally fused family.
2. Emotional Triangle: when a two-person system has instability or stress, a 3rd person is recruited to increase stability and reduce tension.
   
   1. the lower the level of differentiation in family members, the greater probability to have an emotional triangle.
3. Family Projection Process: parental conflicts and emotional immaturity are transmitted to children, which cause a child to have a lower level of differentiation than parents.
   
   1. Most at risk: first child, child of stress, or ‘special’ child

Bowen: multigenerational transmission process in which progressively lower levels of differentiation are transmitted from one generation to the next.

GOAL: to increase the differentiation of all family members.

Techniques:

• Therapist as 3rd triangle member
• work only with most differentiated member to lift others up
• assessments, genograms
• therapist as coach/expert to help members achieve greater differentiation.
• questioning and answering to the therapist
• educative, cognitive, and controlled…reduce emotion

Question 5

3.O

Structural Family Therapy

minuchin

Answer 5

Structural Family Therapy: Minuchin: here/now, directive, concrete approach.

families have an implicit structure, power hierarchies, subsystems.

BOUNDARIES:

1. barriers or rules that determine the amount of contact that is allowed between family members.
2. overly rigid boundaries: family members are disengaged and isolated
3. diffuse boundaries: family members are enmeshed
4. Chronic Boundary problems/Rigid Triads:
   
   1. Detouring: parents focus on the child wither by overprotecting or blaming/scapegoating the child for the family problems
   2. Stable Coalition: parent-child form a cross-generational coalition and consistently ‘gang-up’ against the other parent.
   3. Triangulation: Unstable Coalition: each parent demands that child side with him against the other parent.

Maladaptive: inflexible family structure that prohibits the family from adapting to maturational and situational stressors in a healthy way.

GOALS: restructuring the family, symptom relief.

Techniques:

• Action precedes understanding,
• Change behaviors rather than fostering insight!

1. Joining: family as a leader using…
   
   1. blending with the family, tracking and mimesis (adopting the family affective and communication style). real integration!
2. Evaluating the Family Structure:
   
   1. evaluate transactional patterns, power hierarchies, boundaries.
   2. make a structural diagnosis to derive therapy goals
   3. may include family structural map
3. Restructuring the Family:
   
   1. deliberately unbalance (stress) the family homeostatis in order to transform the family structure.
   2. enactment: role-play
   3. reframing: relabeling bx to view in more positive ways.

Question 6

4.0

Strategic Family Therapy

Answer 6

Haley: Strategic Family Therapy: communication/interaction, structural, Erickson’s hypnotic techniques, and paradoxical directives all used.

1. Focus on communcation in maladaptive behavior: how it is used to exert control in a relationship.
2. symptoms are interpersonal phenomenon: struggles to control other and denies intent to control.
3. GOALS: alleviating current symptoms by altering family’s transactionas and organization, esp. hierarchies and generational boundaries.
4. behavior change results in changes in perceptions and emotions.

Highly structured First Session: Social stage, problem stage, interaction stage, goal-setting stage.

Therapist is: active, take-charge role, directives, homework

Paradoxical Interventions: help family see symptom in an alternative way and they have control of behavior.

• Ordeals*: unpleasant tasks one must do whenever symptom occurs.
• restraining*: do not change
• Prescribing the symptom*: deliberately engage in the symptom

strategic way to intervene.

Question 7

5.0

Milan Systemic Family Therapy

Answer 7

by Selvini-Palazzoli, child analyst treating kids with anorexia

1. circular patterns of actioin and reaction
   
   1. maladaptive bx: when family’s patterns become so fixed that members are no longer able to act creatively or make new choices about their lives.
2. GOAL: to help family members see their choices and assist them to exercise prerogative of choosing. See things differently.
3. Therapeutic Team: one-way mirror, bug in ear
   
   1. Hypothesizing: first session and then tested
   2. Neutrality: therapist is always ally to all family
   3. Paradox: counterparadox (double-bind), positive connotation (reframing).
      
      1. do so not to elicit resistance (strategic), but to provide members with info that will help them derive solutions to their own problems.
   4. Circular Questions: to help each member recognize differences and similarities in their perceptions. Each member asked “who was more upset, mom or dad”

Question 8

6.0

Behavioral Family Therapy

Answer 8

Operant conditioning, social learning, social exchange theroy.

1. all behavior is learned and maintained by its antecedents and consequences.
2. alter the environmental factors (A/C) that maintain the Bx.
3. focus on observable bx
4. ongoing assessemnt of bx to id the appropriate targets of therapy and the effects
5. increase or decrease target bx through the use of contingent reinforcement
6. improve communication and problem-solving skills
7. Stuart’s Operant Interpersonal Therapy: to increase the number and range of positive reinforcements exchanged by partners.
8. greater emphasis on Cognitive-Behavioral Therapy

Question 9

7.0

Object Relations Family therapy

Answer 9

Maladaptive BX: result of both intrapsychic and interpersonal factors

1. Projective Identification: family member projects old introjects onto another family member and then reacts to that person as though they actually have the projected characteristic or provokes the person to act in ways consistent with those characteristics.
2. GOAL: resolve each family member’s attachment to family introjects.
   
   1. interpreting transferences, resistances, to foster insight: essential to change.
   2. MULTIPLE TRANFERENCES: transferences of one member to another, to the therapist, and of the family as a whole to the therapist.