Family Therapy Flashcards
Key figures in family therapy
1940s: Gregory Bateson
1950s: Nathan Ackerman
Murray Bowen
Carl Whitaker
Theodore Lidz
Lyman Wynne
Ivan Boszormenyi-Nagy
John Elderkin Bell
Christian Midelfort
1960s: Don Jackson
Jules Riskin
Virginia Satir
Richard Fisch
Jay Haley
Paul Watzlawick
John Weakland
Salvador Minuchin
1970s (Milan associates): Mara Selvini Palazzoli
Luigi Boscol
Gianfranco Cecchin
Guiliana Prata
(Page 358).
Nonsummativity
(Page 359).
– The whole is greater than the sum of its parts. Components of a system can be understood only within the context of the whole system.
(Page 359).
Boundaries
(Page 359).
the borders that separate a family system from other systems. This makes the family a distinct entity.
(Page 359).
Circular causality
(Page 359).
replaces linear cause and effect.
(Page 359).
Equifinality
(Page 359).
there are multiple causes for any behavior or event and multiple effects flowing from any behavior or event. This is one of the fundamental concepts of the systems perspective.
(Page 359).
Characteristics of a Healthy Couple (Becvar &Becvar, 1996)
Attitudes and Beliefs
(Page 360).
- Belief in multiple realities; therefore, every perception is equally valid.
- Perceptions are fallible; therefore, differences can promote growth rather than struggle.
- People are basically neutral or benign. The motives of one’s partner are usually decent.
- Human encounters are typically rewarding.
- Partners have a systemic perspective:
- An individual needs to be part of a group in order to have definition, coherence, and satisfaction.
- Causes and effects are interchangeable.
- Behavior is a result of many variables rather than a single cause.
- Humans are limited and finite and therefore cannot meet the many needed satisfactions to be found in relationships.
(Page 360).
Characteristics of a Healthy Couple (Becvar &Becvar, 1996)
Behavior Patterns
- Overt power difference is minimal.
- There are clear boundaries.
- The couple operates primarily in the present.
- There is a respect for individual choice.
- Skill in negotiating is apparent.
- Positive feelings are shared.
(Page 360).
Characteristics of a Healthy Family as Listed by Becvar and Becvar (1996):
(Page 361).
- A legitimate source of authority established and supported overtime
- A stable rule system established and consistently acted upon
- Stable and consistent sharing of nurturing behavior 4. Effective and stable childrearing and marriage-maintenance practices
- A set of goals toward which the family and each individual works
- Sufficient flexibility and adaptability to accommodate normal development challenges as well as unexpected crises
(Page 361).
Life Stage Cycles: Early stages: Forming and nesting
(Page 361).
- Coupling is when the family begins by establishing a common household with two people.
Task: Shift from individual independence to couple interdependence. - Becoming three is the stage initiated by the arrival of the first child.
Task: Interdependence to incorporation of dependence.
(Page 361).
Life Stage Cycles: Middle stages: Family separation process
(Page 361).
- Entrances is a stage signaled by the exit of the first child from the family to the larger world.
Task: Dependence to partial independence. - Expansion is a phase marked by the entrance of the last child into the larger world.
Task: Support of continuing separations. - Exits refers to the first complete exit of a dependent member of the family. It is achieved by establishment of an independent household.
Task: Partial separations to first complete independence.
(Page 361).
Life Stage Cycles: Last stages: Finishing
(Page 361).
- Becoming smaller/extended is the exit of the last child from the family.
Task: Continuing expansion of independence. - Endings are the final years that begin with the death of one spouse and continue to the death of the other partner.
Task: Facilitation of family mourning. Working through final separations.
(Page 361).
Psychodynamic Family Therapy (key figures)
Important Figures: David Scharff
Jill Scharff
Secondary Figures: Nathan Ackerman James Framo Robin Skynner Melanie Klein Samuel Slipp
(Page 363).
Goal of Psychodynamic Family Therapy
Therapists seek to understand the development of the individual personality in the context of early parent-child relationships. And to “expand the family’s capacity to perform the holding functions for its members and their capacities to offer holding to each other.” As well as to aid family in expressing true understanding and compassion.
(Page 363).
Object relations theory
(Page 365).
the combination of the study of individuals and their basic motives (psychoanalysis) and the study of social relationships (family therapy). “One looks for the dynamic and personal historical reasons for problems in current relationships” (Becvar & Becvar, 1996).
(Page 365).
Splitting
(Page 365).
to children separating their internal world into good and bad aspects. This is an evolving process consistent with their developmental stage.
(Page 365).
Four phases of development in object relations:
(Page 365).
- Differentiation occurs when children develop to the point that they can explore aspects of mother and others.
- Practicing is the stage in which children explore the world.
- Rapprochement occurs as children have an increased awareness of their vulnerability and separateness. They repeatedly return to mother for reassurance.
- Object relations constancy is achieved as the child realizes his/her separation but relatedness to his/her parents.
(Page 365).
Transference
(Page 365).
to elements of an individual’s earlier experience and suggests that a person is being related to based on an amended version of the other person involved.
(Page 365).
Countertransference
(Page 365).
the reciprocal interaction of the other person in the face of transference.
(Page 365).
Internal objects
(Page 365).
mental images of the self and others built from experience and expectation.
(Page 365).
Introjection
(Page 365).
“the child reproducing and fixating his/her interactions with the environment by organizing memory traces that include images of the object, the self interacting with the object, and the associated affect (can be good or bad)” (Nichols and Schwartz, 2001, p. 204).
(Page 365).
Identification
(Page 365).
involves the internalization of a role. The child takes on certain roles and behaves as his/her parents did.
(Page 365).
Ego identity
(Page 365).
is a synthesis of identifications and introjections. It provides a sense of coherence and continuity.
(Page 365).
Holding environment
(Page 365).
emphasizes the need for closeness yet separateness in order to achieve whole object relations.
(Page 365).
Transitional objects
(Page 365).
neither self nor object yet are treated as if they were the beloved parent and the self.
(Page 365).
Techniques – Psychodynamic
(Page 366).
A. Recognition and reworking of the defensive projective identifications that have been required in the family
B. Provide contextual holding for family members so that their attachment needs and conditions for growth may be achieved
C. Reinstatement or construction of the necessary holding relationships between each of its members to support their needs for attachment, individuation, and growth
D. Return of family to overall developmental level appropriate to its tasks as determined by its own preferences and by the needs of the family members
E. Clarification of individual needs so they can be met with as much support as is needed from the family
(Page 366).
SATIR’S EXPERIENTIAL FAMILY THERAPY overview
(Virginia Satir)
(Page 367).
A. The basic philosophy underlying the model begins with the belief that humans have an innate growth tendency in terms of body, mind, and feelings.
B. Systems (both human and greater systems) are viewed as holistic systems and are viewed as continually interacting via communication to form a dynamic whole.
C. The basic components in these systems are:
- rules influence roles which have an impact on the effectiveness of functioning
- an awareness of experience in the here and now allows for growth to occur in individual, family, and larger societal systems
D. The focus of therapy lies on enhancing self-esteem and addressing interpersonal communication.
(Page 367).
Goals of Treatment – Satir’s Experiential
(Page 367).
A. The general goal is to facilitate growth in the family and between its members in terms of self-esteem and effective communication.
B. Other goals:
- Instill hope and encouragement in family members
- Access, enhance, and create coping skills
- Facilitate growth-oriented movement in the family beyond simple symptom relief by releasing and directing energy that was previously tied up in symptomatic behaviors
(Page 367).
Role of the Counselor – Satir’s Experiential
(Page 367).
A. To create a comfortable, safe environment in order to encourage the ability of families to examine their behavior
B. To reframe negative emotions such as anger as pain and encourage expression of feeling in therapy
C. To educate clients in their roles of self-control and accountability
D. To address noncongruent communication regarding content and process messages
E. To model congruent communication
(Page 367).
Role of the Symptom – Satir’s Experiential
(Page 368).
A. Symptoms are framed within a relational perspective.
B. Symptoms signal blockages in growth.
C. The balance of the system is maintained through this blockage and has a survival connection to the system.
(Page 368).
The 7 mutually reinforcing functions:
(Satir’s Experiential)
(Page 368).
- To provide a sexual experience for the mates
- To contribute to the continuity of the race by producing and nurturing children
- To cooperate economically by dividing labor between adults according to gender, convenience, and precedents and between adults and children according to the child’s age and gender
- To maintain a boundary (by the incest taboo) between the generations so that smooth task-functioning and stable relationships can be maintained 5. To transmit culture to the children by parental teaching
- To recognize when one of the members is no longer a child but has become an adult capable of performing adult roles and functions
- To provide for the eventual care of parents by their children
(Page 368).
Development of Behavioral Disorders
(Satir’s Experiential)
(Page 368).
A. The family is a closed system with poor interchange of information and resources within and without the system. Such interchange is maladaptive and rigid.
B. The presence of dysfunction in one member is symptomatic of dysfunction in one of the larger systems (usually the family).
C. Coping is viewed as the problem rather than the presence of stress or difficulty.
D. Rules are fixed, arbitrary, and inconsistently applied. E. These rules maintain the status quo and are geared toward maintaining the self-esteem of the parents.
F. The end result is chaos of the family.
(Page 368).
Key concepts and terminology (Satir Experiential)
- Self esteem
- Communication
- Congruent
- Incongruent
- Roles
- Blamer
- Placater
- Super reasonable
- Irrelevant
- Congruent
- Rules
- Rigid
- Flexible - Human mandala (individual growth)
- physical body
- intellect
- emotions
- the five senses
- social needs
- nutritional needs
- life space needs
- spiritual needs
(Page 369).
Family Sculpting
techniques Satir
a psychodrama technique in which a family member enacts a feeling or family structure. The goal is to offer a symbolic representation of family dynamics.
(Page 370).
Family life fact chronology
(techniques Satir)
(Page 370).
a history collected by the therapist. It traces the family time line and offers them an accepting environment in which to share relationship patterns.
(Page 370).
Reframing
(techniques Satir)
(Page 370).
reinterpretation of problems in order to shift the perspective of the client system.
(Page 370).
Verbalizing presuppositions
(techniques Satir)
(Page 370).
the therapist making the presuppositions of the family overt as they are viewed in the behavior of the family.
(Page 370).
Denominalization
(techniques Satir)
(Page 370).
the giving of behavioral descriptions for feelings (such as love) in order to determine the individuals’ perception of what must happen in order for them to perceive they are receiving that behavior. It is typically languaged in terms of sensory-based representational systems such as visual, auditory, or kinesthetic.
(Page 370).
Anchoring
(techniques Satir)
(Page 370).
the process of relating a physical stimulus (i.e., a touch on the shoulder) with a previous experience.
(Page 370).
Multiple family therapy
(techniques Satir)
(Page 370).
therapy with several unrelated family systems.
(Page 370).
WHITAKER’S EXPERIENTIAL FAMILY THERAPY
Key figures
(Page 371).
A. Major Figure: Carl Whitaker
B. Secondary Figures: Walter Kempler; August Napier; David Keith; Fred and Bunny Duhl
(Page 371).
Overview – Whitaker’s Experiential
(Page 371).
A. Experiential therapy emphasizes the immediate here and now.
B. The focus of therapy is the quality of ongoing experience.
C. Emotional expression is considered to be the medium of shared experience and the means to fulfillment.
(Page 371).
Goals of Treatment – Whitaker’s Experiential
(Page 371).
A. The aim of therapy is to help individuals grow and to enable them to do so in the context of their families.
B. To enable family members to experience themselves both as a system and as individuals who are able to become unstuck.
(Page 371).
Role of the Counselor – Whitaker’s Experiential
(Page 371).
A. The therapist is caring and enters the system. The role of expert is assumed and directives are offered to the client.
B. The therapist maintains a neutral stance.
C. Through the phases of therapy, the therapist gradually increases the level of anxiety experienced by the family.
D. Through paradox, the therapist escalates pressure to produce a psychotic-like episode so the client will reintegrate in a new and meaningful manner.
(Page 371).
Role of the Symptom – Whitaker’s Experiential
(Page 371).
Although symptom relief is viewed as important, it is secondary to:
- increased personal integrity
- greater freedom of choice
- less dependence
- expanded experiencing
(Page 371).
Normal Family Development
(Whitaker’s Experiential)
(Page 372).
A. Healthy families are able to self-actualize.
B. They grow despite the problems and pitfalls they encounter along the way.
C. They have similar processes of interaction that demonstrate appropriate levels of autonomy and a high degree of role flexibility.
D. The family members are free to join and separate as they choose.
E. The family has its own set of stories, and the various systems are open and available for interaction with other systems in their network.
F. No one family member is the primary symptom-bearer. Each member carries the symptom from time to time.
(Page 372).
Development of Behavioral Disorders
(Whitaker’s Experiential)
(Page 372).
A. Dysfunctional families deny feelings and are either enmeshed or disengaged.
B. They are self-protective and avoid risk-taking.
C. They are rigid and mechanical rather than spontaneous and free.
D. They have a belief that confrontation and open conflict would destroy the family, so the family is unable to grow.
E. Alienation from experience, leading to a lack of autonomy and intimacy, is the key to a family’s dysfunction. It is portrayed both in individual problems and in interpersonal relationships.
F. The battle for control of whose family of origin will provide the model for procreation also plays a role in dysfunction.
(Page 372).
Phases of therapy (Whitaker’s Experiential)
- Engagement is the first phase of therapy in which joining takes place.
- Involvement is the longest phase of therapy and involves the highest level of change for the therapeutic process. As the client becomes more committed to therapy, he or she is more invested in change occurring.
- Disentanglement is the final phase of therapy and involves the gradual separation of therapist from client. At this phase, the therapist should have empowered a client and reinforced the need for continued growth.
(Page 373).
STRUCTURAL FAMILY THERAPY
Key figures
(Page 374).
A. Major Figure: Salvador Minuchin
B. Secondary Figures: Harry Aponte; Jorge Colapinto; Charles Fishman; Braulio Montalvo; Bernice Rosman
(Page 374).
Structural Overview
A. Minuchin offered a theory of family structure.
B. He believed that families come into therapy because they see themselves as stuck.
C. Therapy is designed to unfreeze a family from these rigid patterns of behavior and create the opportunity for new structures to emerge.
(Page 374).
Goals of Treatment – Structural
(Page 374).
A. The goal of structural family therapy is to change the underlying systemic structure of the family and thereby address the presenting problems.
B. Secondary goals specific to the problem are determined by diagnosis of the structure and the therapeutic stage.
(Page 374).
Role of the Counselor – Structural
(Page 374).
A. The therapist becomes an active participant in the system in order to change the structure.
B. The therapist takes on the role of expert and is active and directive.
C. The therapist is encouraged to use a flexible approach and integrate his or her personal style.
(Page 374).
Role of the Symptom – Structural
(Page 374).
A. Typically one family member will serve as the symptom bearer in order to relieve pressure from the dysfunctional family system.
B. The family is then enabled to focus its attention on the symptom bearer rather than on the pain it is experiencing.
(Page 374).
Normal Family Development – Structural
(Page 375).
A. Couple formation takes place as two individuals negotiate boundaries with families of origin, reconcile divergent life styles, and develop rules of interaction. B. Family with young children is the stage in which the marital dyad structure reorganizes to adapt to the role of parents.
C. Family with school age and adolescent children takes the family into a phase of interaction with external systems such as the school system and peers. The family must deal with issues relating to loss of parental control and increasing autonomy of the children.
D. Family with grown children reorganizes its structure from parental to adult-to-adult interaction.
(Page 375).
Development of Behavioral Disorders
(Structural)
(Page 375).
A. Behavioral disorders occur when family structures are inflexible and they cannot adjust to the developmental or environmental stressors.
B. The dysfunction arises because the family cannot realign its structure in order to meet these challenges. C. The inflexibility may be due to inherent flaws in the structure or in the ability to transition to the next family stage.
D. There are four forms of pathology associated with the structural perspective:
- 1. Pathology of boundaries in which boundaries are too rigid or too diffuse.
- 2. Pathology of alliances in which relationships that are not conducive to family functioning are either conflict detouring or inappropriate cross-generational coalitions.
- 3. Pathology of triad (or triangles) in which two members have an alliance against a third member.
- 4. Pathology of hierarchy in which a child is parentified and a parent is excluded from the parental subsystem.
(Page 375).
Joining and accommodating
(Structural techniques)
(Page 378).
for the purpose of establishing an effective working relationship between the therapist and the client system.
(Page 378).
Accommodation
(Structural technique)
(Page 378).
when the therapist modifies their language, tone, or style in order to join with the client.
(Page 378).
