Family Therapy Flashcards
When did some clinicians, dissatisfied with slow progress of working with individual patients, began to look at the family as the locus of pathology
1950s
What is unique about family therapy
Identified patient (considered to be problem in the family) is viewed as manifesting troubled or troubling behaviour maintained by problematic transactions within the family or between the family and the outside community.
Family therapists pay attention to what 2 thinngs
- Family’s structure (how it arranges, organizes and maintains itself)
- Family process (the way it evolves, adapts or changes over time)
Organization and wholeness
A key concept to understanding how systems operate. Systems are composed of units that stand in some consistent relationship to one another, and thus we can infer that they are organized around Those relationships. In a similar way, units or elements produce an entity when they are combined. A change in one part causes a change in other parts and the entire system. No element within the system can be understood in isolation
Who was the first to see how the family might operate as a cybernetic system? What did he research
Gregory Bateson.
Study on schizophrenia and family interaction.
Cybernetic epistemology
Instead of assuming that one individual causes another’s behaviour, believe that both participants are caught in a circular interaction, a chain reaction that feeds back on itself because each family member had deforms the situation differently
Linear causing
A simple nonreciprocal view that one event leads to another in a stimulus response fashion
Circular causality
Reciprocal actions occur within a relationship network by means of a network of interacting loops. Any cause is seen as an effect of a precious cause and becomes in turn the cause for a later event
Cybernetics
Based on Greek word for steersman. Describes the regulatory systems that operate by means of feedback loops. Eg. Thermostat. When a crisis occurs in the family, family members maintain or regain a stable environment by activating learned mechanisms to decrease the dress. Rely on exchange of jnfo
Negative feedback
Attenuating effect, restoring equilibrium
Positive feedback
Leads to further change by accelerating the deviation
Explain family therapy and subsystems
Families are made up of several coexisting subsystems in which members carry out certain functions. A wife may also be a mother and a daughter. In dysfunctional situations, family members may sit into separate long term coalitions like males vs females.
Although family members may engage in temporary alliances, what 3 key subsystems will always endure
- Spousal
- Parental
- Sibling
Boundaries
Invisible lines that separate a system, subsystem, or individual from outside surroundings. Protect integrity and distinguish insiders from outsiders. Gary from rigid to diffuse. Excessively rigid boundaries lead to disengaged families and diffuse boundaries lead to enmeshed families
Open system
Family is open to new experiences, is able to alter and discard unworkable or obsolete interactive patterns
Closed system
Boundaries not easily crossed, family is insular, not open to what is happening around it, suspicious of the outside world
Second order cybernetics
Acknowledged effect of observer (family therapist) on his or her observations. By helping define the problem, observer influences goals and outcomes
Gender sensitive outlook in family therapy
Careful not to reinforce patriarchal attitudes or class differences
Most family therapists view personality from what perspective
Family life cycle. Notes that certain predictable marker events or phases occur in all families and each family deals with it in some manner. Situational family c rises and certain key transition points are periods of special vulnerability. Ordinarily changes are gradual but certain discontinuous changes may be disruptive.
Family rules
Family therapists are especially interested in persistent, repetitive behavioural consequences that characterize much of what these patterns reveal about the family’s interactive patterns
Redundancy principle
Used to describe a family’s usually restricted range of options for dealing with one another. Don Jackson said they family dysfunction resulted from a lack of rules for accommodating changing conditions
Family narratives and assumptions
Some families view world as friendly, trustworthy and orderly. Others view the world as menacing, unstable and unpredictable. Families inevitably create narratives about themselves, linking certain family experiences together in a sequence to justify how they live as they do. Eg. Parents divorce frightened them about commitment to relationships
Pseudo mutuality
Expressing both positive and negative emotions to one another. Members in these families were absorbed with fitting in together at the expense of developing separate identities
Pseudohostility
Apparent quarrelling or bickering between family members is in reality merely superficial tactic for avoiding deeper and more genuine feelings
Mystification
Masking effort to obscure the real nature of family conflict. Parental efforts to distort a child’s experience by denying what ten child believes is occurring. This contradicts one person’s perceptions and leads that person to question grip on reality. Eg. You must be tired; to to bed
Scapegoating
A particular individual is held responsible for whatever is wrong with the family. Scapegoated family members are themselves often active participants and assume the role assigned to them
There is no single theory of psychotherapy for family therapists. Although all would agree with the following 7 basic premises
- People are products of their own connections, and attempts to help them must take family relationships into account
- Symptomatic or problematic behaviour in an individual arises from a context of relationships and interventions to help that person are lost effective when those faulty interactive patterns are altered
- Individual symptoms are maintained externally in current family system interactions
- Conjoint sessions, in which the family is the therapeutic unit and the focus is on family interaction, are more effective in producing change than attempts to uncover intrapsychic problems in individuals via individual sessions
- Assessing family subsystems and the permeability of boundaries within and family and between the family and the outside world offers important clues regarding family organization and susceptibility to change
- Traditional psychiatric diagnostic labels based on individual psychopathology fail to provide an understanding of family dysfunctions and tend to pathologize individuals
Monadic model
Based on the characteristics of a single person
Dyadic model
Based on a two person interaction
Triadic model
Based on interactions between 3+ people
Even though the idea that symptoms may serve a purpose in helping maintain family stability has been a mainstay of family therapy theory, critics argue that…
It suggests that families need a sick member and are willing to sacrifice that person for the sake of family wellbeing
Narrative therapists
Reject notion that a child’s problems necessarily reflect more serious underlying family conflict. Families may be oppressed rather than protected by the symptomatic Behavior
First order changes
Changes within the system that do not alter the organization itself
Eg Bryan’s parents don’t want him to keep skipping school so they ground him
Second order changes
Fundamental changes in a system’s organization and function
Eg. Ryan’s parents don’t want him to keep skipping school, but they recognize that his relationship with the school is truly his own and they should back off from intruding. Tell Ryan that from now on he would be responsible for his own education
Initial contact in family therapy
Begins when client asks for help. Asses how self aware the caller is, what impression they’re trying to make, if other members are involved and if they are all willing to attend the initial session. Therapist’s first opportunity to enter into the family system
The initial session in family therapy
Encourage as many family members as possible to attend. When they enter the room, encourage them to sit where they wish and their chosen seating arrangement is an early clue about possible family alliances and coalitions. Welcome all members separately as equally important participants. Observe family interactive patterns
Engaging the family
Build a working alliance. Assimilate their language and manner of expression to show them that they are cared about and that it is a safe climate
Assessing family functioning
- Is treatment for the entire family needed?
- Who are the appropriate family members with whom to work?
- What underlying interactive patterns fuel the family disturbance and lead to symptoms in one or more of its members?
- What specific interventions will most effectively help this family?
Use questionnaires to pinpoint which behaviours need to be altered. Extent of problem. Environmental cues that trigger behaviour. Behaviours of family members thaT maintain the problem
Carl Whitaker
An experiential therapist. Insists on controlling the structure of the therapy at the start of treatment, making certain that family is not successful in imposing its own definition of the upcoming therapeutic relationship and how it should proceed. Family members must be encouraged to take responsibility for changing the nature of their relationships
Salvador Minuchin
Says you get a better sense of how families function by interacting with them for a period of time than from any formal assessment process. How subsystems carry out family tasks, how alliances and coalitions operate, how flexible family rules are, how permeable the boundaries are within the family and between the family and the outside world
History taking
Object relations family therapists contend that history needs to be taken. Especially interested in why marital partners chose each other. Bowen believed that dysfunction may result from poor differentiation from families of origin
Family genogram
A schematic diagram in the form of a family tree, usually including at least 3 generations, to trace recurring family behaviour patterns.
Satir
Tried to get families to think about the relevant concepts that formed the basis of their developing relationships by compiling a family life chronology for each member. Represented an effort to help people see how family ideology had emerged in the family and influenced current family functioning.
Structural and strategic family therapists
Pay less attention to family or individual history and prefer to focus on current family organization, coalitions, hierarchies, etc
Social constructionists
Pay particular attention to how the various family members view their world rather than attempting to act as outside observers evaluating client responses. Any preconceived views by the therapist of what constitutes a functional family fail to attend to the diversity inherent in today’s pluralistic society
List 8 therapeutic techniques used by therapists to alter family functioning
- Reframing
- Therapeutic double binds
- Enactment
- Family sculpting
- Circular questioning
- Cognitive restructuring
- Miracle question
- Externalization
Reframing
Relabelling problematic behaviour by viewing it in a new, more positive light that emphasizes it’s good intention
Therapeutic double binds
Directing family members to continue to manifest they present symptoms. By doing this, therapist is demanding that the presentation of the symptom, which they have claimed is involuntary, and thus out of their control, can be done voluntarily
Enactment
Role playing efforts to bring the outside family conflict into the session so that family members can demonstrate how they deal with it and the therapist can start to devise an intervention procedure for modifying their interaction and creating structural changes in the family
Family sculpting
Family members take a turn at being a director, placing each of the other memories in a physical arrangement in space. The result is often revealing of how the director perceives his or her place in the family, as well as that person’s perception of what is being done to whom, by whom, and in what manner.
Circular questioning
Used to focus attention on family connections rather than individual symptomology. Each question posed to the family by the therapist addresses differences in different members’ perceptions about the same events or relationships. By asking several members the same question, therapist is able to prove more deeply without being confrontational
Cognitive restructuring
Based in the idea that problematic behaviour stems from maladaptive thought processes. Tries to modify a client’s precept ions of events to bring about behavioural change. It is the interpretation that causes havoc, not the quarrel itself
Miracle question
Solution focused technique in which clients are asked to consider what would occur if a miracle took place, and, upon awakening in the morning, they found the problem they brought to therapy solved
Externalization
In an effort to liberate a family from its dominating, problem saturated story, narrative therapists employ this technique to help families separate the symptomatic member’s identity from the problem for which they sought help. The problem is recast as residing outside the family, rather than implying an internal family deficiency or individual pathological condition, and as having a restraining influence over the life of each member in the family. Instead of focusing on what’s wrong with the family, all are called on to unite to deal with this external and unwelcome story with a will of its own that dominates their lives.
Eg. Rather than mother is depressed, depression is trying to control mother’s life
Depending on their specific emphases, family therapists may try to help clients achieve one or more of the following changes
- Structural change
- Behavioural change
- Experiential change
Structural change
Having assessed the effectiveness of the family’s organizational structure and its ongoing transactional patterns, therapists actively challenge rigid, repetitive patterns that handicap optimal functioning of family members. Help families modify Unworkable patterns.
Behavioural change
Help clients achieve desired behavioural changes.
Strategic therapists focus treatment in current problems. What they came in for. Don’t let family manipulate you into changing treatment. Be directive. Through directives like paradoxical interventions, force them to abandon old dysfunctional behaviour.
Systemic therapists may assign tasks for family to carry out. Typically I’m paradoxical form and call for the performance of a task that challenges an outdated and rigid family rule
Experiential change
Families need to feel and experience what previously was locked up. efforts directed at growth producing transactions where therapists act as models of communication, willing to disclose and expre their own c reliefs. Help them communicate, help them ask for what they want from one another, give voice to underlying impulses. Realize what they have hidden their primary emotions
Cognitive change
Psychodynamically oriented therapists interests in providing families with insight and understanding. Inter generational issues. How relationship patterns are passed on. Gain insight into introjects projected into current family members.
