Family Therapy

Question 0

When did some clinicians, dissatisfied with slow progress of working with individual patients, began to look at the family as the locus of pathology

Answer 0

1950s

Question 1

What is unique about family therapy

Answer 1

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.

Question 2

Family therapists pay attention to what 2 thinngs

Answer 2

1. Family’s structure (how it arranges, organizes and maintains itself)
2. Family process (the way it evolves, adapts or changes over time)

Question 3

Organization and wholeness

Answer 3

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

Question 4

Who was the first to see how the family might operate as a cybernetic system? What did he research

Answer 4

Gregory Bateson.

Study on schizophrenia and family interaction.

Question 5

Cybernetic epistemology

Answer 5

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

Question 6

Linear causing

Answer 6

A simple nonreciprocal view that one event leads to another in a stimulus response fashion

Question 7

Circular causality

Answer 7

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

Question 8

Cybernetics

Answer 8

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

Question 9

Negative feedback

Answer 9

Attenuating effect, restoring equilibrium

Question 10

Positive feedback

Answer 10

Leads to further change by accelerating the deviation

Question 11

Explain family therapy and subsystems

Answer 11

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.

Question 12

Although family members may engage in temporary alliances, what 3 key subsystems will always endure

Answer 12

1. Spousal
2. Parental
3. Sibling

Question 13

Boundaries

Answer 13

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

Question 14

Open system

Answer 14

Family is open to new experiences, is able to alter and discard unworkable or obsolete interactive patterns

Question 15

Closed system

Answer 15

Boundaries not easily crossed, family is insular, not open to what is happening around it, suspicious of the outside world

Question 16

Second order cybernetics

Answer 16

Acknowledged effect of observer (family therapist) on his or her observations. By helping define the problem, observer influences goals and outcomes

Question 17

Gender sensitive outlook in family therapy

Answer 17

Careful not to reinforce patriarchal attitudes or class differences

Question 18

Most family therapists view personality from what perspective

Answer 18

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.

Question 19

Family rules

Answer 19

Family therapists are especially interested in persistent, repetitive behavioural consequences that characterize much of what these patterns reveal about the family’s interactive patterns

Question 20

Redundancy principle

Answer 20

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

Question 21

Family narratives and assumptions

Answer 21

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

Question 22

Pseudo mutuality

Answer 22

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

Question 23

Pseudohostility

Answer 23

Apparent quarrelling or bickering between family members is in reality merely superficial tactic for avoiding deeper and more genuine feelings

Question 24

Mystification

Answer 24

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

Question 25

Scapegoating

Answer 25

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

Question 26

There is no single theory of psychotherapy for family therapists. Although all would agree with the following 7 basic premises

Answer 26

1. People are products of their own connections, and attempts to help them must take family relationships into account
2. 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
3. Individual symptoms are maintained externally in current family system interactions
4. 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
5. 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
6. Traditional psychiatric diagnostic labels based on individual psychopathology fail to provide an understanding of family dysfunctions and tend to pathologize individuals

Question 27

Monadic model

Answer 27

Based on the characteristics of a single person

Question 28

Dyadic model

Answer 28

Based on a two person interaction

Question 29

Triadic model

Answer 29

Based on interactions between 3+ people

Question 30

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…

Answer 30

It suggests that families need a sick member and are willing to sacrifice that person for the sake of family wellbeing

Question 31

Narrative therapists

Answer 31

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

Question 32

First order changes

Answer 32

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

Question 33

Second order changes

Answer 33

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

Question 34

Initial contact in family therapy

Answer 34

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

Question 35

The initial session in family therapy

Answer 35

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

Question 36

Engaging the family

Answer 36

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

Question 37

Assessing family functioning

Answer 37

1. Is treatment for the entire family needed?
2. Who are the appropriate family members with whom to work?
3. What underlying interactive patterns fuel the family disturbance and lead to symptoms in one or more of its members?
4. 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

Question 38

Carl Whitaker

Answer 38

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

Question 39

Salvador Minuchin

Answer 39

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

Question 40

History taking

Answer 40

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

Question 41

Family genogram

Answer 41

A schematic diagram in the form of a family tree, usually including at least 3 generations, to trace recurring family behaviour patterns.

Question 42

Satir

Answer 42

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.

Question 43

Structural and strategic family therapists

Answer 43

Pay less attention to family or individual history and prefer to focus on current family organization, coalitions, hierarchies, etc

Question 44

Social constructionists

Answer 44

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

Question 45

List 8 therapeutic techniques used by therapists to alter family functioning

Answer 45

1. Reframing
2. Therapeutic double binds
3. Enactment
4. Family sculpting
5. Circular questioning
6. Cognitive restructuring
7. Miracle question
8. Externalization

Question 46

Reframing

Answer 46

Relabelling problematic behaviour by viewing it in a new, more positive light that emphasizes it’s good intention

Question 47

Therapeutic double binds

Answer 47

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

Question 48

Enactment

Answer 48

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

Question 49

Family sculpting

Answer 49

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.

Question 50

Circular questioning

Answer 50

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

Question 51

Cognitive restructuring

Answer 51

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

Question 52

Miracle question

Answer 52

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

Question 53

Externalization

Answer 53

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

Question 54

Depending on their specific emphases, family therapists may try to help clients achieve one or more of the following changes

Answer 54

1. Structural change
2. Behavioural change
3. Experiential change

Question 55

Structural change

Answer 55

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.

Question 56

Behavioural change

Answer 56

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

Question 57

Experiential change

Answer 57

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

Question 58

Cognitive change

Answer 58

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.