Family Therapy

Question 1

Life Cycle stage

Answer 1

Life cycle stages refer to the predictable marker events or phases through which a family progresses. They may occur due to a change in family composition or a major shift in autonomy. The stages as listed by Goldenberg and Goldenberg (2000) are as follows:
1. Early stages: Forming and nesting
 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.
2. Middle stages: Family separation process
 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.
3. Last stages: Finishing
 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.

Question 2

Psychodynamic Family Therapy

Answer 2

A. Important Figures: David Scharff and Jill Scharff
B. Secondary Figures: Nathan Ackerman ,James Framo
Robin Skynner, Melanie Klein and Samuel Slipp

Question 3

Psychodynamic Family Therapy is an intergration of:

Answer 3

• psychoanalytic theory
• object relations theory
• family therapy

Question 4

Psychodynamic Family Therapy

object relations theory

Answer 4

is 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”

Question 5

Psychodynamic Family Therapy

Splitting

Answer 5

refers to children separating their internal world into good and bad aspects. This is an evolving process consistent with their developmental stage.

Question 6

Psychodynamic Family Therapy

Four phases of development in object relations:

Answer 6

Four phases of development in object relations:

1. Differentiation occurs when children develop to the point that they can explore aspects of mother and others.
2. Practicing is the stage in which children explore the world.
3. Rapprochement occurs as children have an increased awareness of their vulnerability and separateness. They repeatedly return to mother for reassurance.
4. Object relations constancy is achieved as the child realizes his/her separation but relatedness to his/her parents.

Question 7

Techniques of Psychodynamic Family Therapy

Answer 7

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.

Question 8

Satir’s Experiential Family Therapy

Answer 8

is known as conjoint family therpay

Question 9

Satir’s Experiential Family Therapy

Commuication

Answer 9

Communication is the manner in which we send and receive information. It is the primary influence on relationships. Communication and self worth are viewed as the foundation of the family system.
 Congruent communication is direct, clear communication at the verbal andnonverbal levels. Feelings and experience are matched by words.
 Noncongruent communication involves distorted, incomplete messages. It is ambiguous and typically involves double binds.

Question 10

Satir’s Experiential Family Therapy

Roles of Family Members

Answer 10

1. Blamer – this individual accuses others and controls
2. Placater – goes along with others, pleases, avoids conflict
3. Super reasonable – over analytical and little emotion
4. Irrelevant – distracts others and cannot focus
5. Congruent – engages in honest, open communication of both thoughts and feelings

Question 11

Rules of the family are typically unspoken and influenced by the family roles

Answer 11

 Rigid rules are associated with dysfunction. There is little possible change in the
rules regardless of circumstances or family development.
 Flexible rules are present in families with congruent communication.

Question 12

Satir’s Experiential Techniques

Answer 12

A. Family sculpting is 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.
B. Family life fact chronology is a history collected by the therapist. It traces the family time line and offers them an accepting environment in which to share relationship
patterns.
C. Family reconstruction is the rebuilding of the family through the reenactment of certain aspects of family history. The information for this reconstruction is typically taken from the family chronology.
D. Reframing is reinterpretation of problems in order to shift the perspective of the client system.
E. Verbalizing presuppositions is the therapist making the presuppositions of the family overt as they are viewed in the behavior of the family.
F. Denominalization describes 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.
G. Anchoring is the process of relating a physical stimulus (i.e., a touch on the shoulder)
with a previous experience.
H. Multiple family therapy is therapy with several unrelated family systems.

Question 13

Whitake’s Experiential Family Therapy

Answer 13

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.

Question 14

Whitaker’s Experiential Family Therapy

Goals of Treatment

Answer 14

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.

Question 15

Whitaker’s Experiential Family Therapy

Techniques

Answer 15

A. Three phases of therapy:
1. Engagement is the first phase of therapy in which joining takes place.
2. 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.
3. 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.
B. Redefining symptoms as efforts for growth
C. Modeling fantasy alternatives to real-life stress
D. Separating interpersonal stress and intrapersonal stress
E. Adding practical bits of intervention
F. Augmenting the despair of a family member
G. Affective confrontation is the focus on and emphasis on exploration of feelings
H. Treating children like children and not like peers

Question 16

Whitaker’s Experiential

Answer 16

The model is PRAGMATIC and NONTHEORETICAL

Question 17

Structural Family Therapy

Answer 17

Primary Figure: Salvador Minuchin

Secondary Figures: Harry Aponte Jorge Colapinto
Charles Fishman Braulio Montalvo
Bernice Rosman

Question 18

Structural Family Therapy

Goals

Answer 18

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.

Question 19

Structural Family Therapy

Normal Family Development

Answer 19

The family develops in stages of increasing complexity. Their task is to blend individual growth with integration as a member of the family system. There are typically four stages of development:
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.

Question 20

Structural Family Therapy

Boundaries

Answer 20

Boundaries refer to the invisible barriers that regulate contact between individuals. The degree of permeability (on a continuum from rigid to diffuse) determines the level of contact.
1. Rigid boundaries lead to impermeable barriers between the subsystems.
- This results in a disengaged family in which the subsystems (typically parent and child) are separate and distinct.
-Although autonomy is maintained in a disengaged family, it is at the expense of nurturance, closeness, and involvement.
2. Diffuse boundaries are excessively blurred and indistinct.
-The members typically have little generational hierarchy and parents and children easily trade roles.
-The system is referred to as being enmeshed in which proximity and intensity in family interactions is extreme and family members are overinvolved in each
other’s lives.
-Family members have difficulty developing relationships outside the family system.
3. Clearly defined boundaries between subsystems in a family help maintain separateness yet at the same time emphasize connection to the overall family system.

Question 21

Structural Family Therapy

Techniques

Answer 21

A. Joining and accommodating techniques are for the purpose of establishing an effective working relationship between the therapist and the client system.

1. Accommodation occurs when the therapist modifies their language, tone, or style in order to join with the client.
2. Maintenance is the act of the therapist focusing or highlighting certain behaviors in order to increase the functional aspects of the family structure.
3. Tracking is the use of clarification or amplification of communication to reinforce individuals or subsystems.
4. Mimesis is the adoption of the clients’ communication style by the therapist.

Question 22

Strategetic Family Therapy

Important Figures

Answer 22

Jay Haley and CLoe Madanes

Question 23

Strategetic Family Therapy

Goals

Answer 23

A. The primary goal is to address the presenting problem.
B. Therapists may also address the relational dynamics connected to the symptom but are to avoid working toward insight into relational processes.

Question 24

Strategetic Family Therapy

Normal Family Development

Answer 24

A. The family is viewed as developing as it progresses through a family life cycle consisting of
the following stages:
 marriage
 birth of first child
 reduction in family size
 advanced aging
B. As the family moves from one stage to the next, the functional family is an open system.
C. Clear boundaries, adaptability, and organization
D. Parents are at the top of the family hierarchy.
E. Clear communication is utilized by family members to face the challenges of transition from one developmental stage to the next along with other problems that arise.

Question 25

Strategetic Family Therapy

Techniques

Answer 25

A. Directives are assignments given by the therapist to be performed between sessions. They are a key intervention and are either straightforward or paradoxical.
1. Straightforward directives can include advice, explanations, or suggestions. It is expected that the family will not resist the task. These directives are designed to
change the interactional sequence of the family.
 Metaphorical tasks- are tasks given that are not directly related to the problem. It indirectly facilitates change due to the symbolism and content.
 Devil’s pact- is the commitment a family makes to follow a rigorous task before the task is disclosed by the therapist.
2. Paradoxical directives involve tasks in which success is based on either the family defying the instructions or following them to an absurd extreme and then withdrawing.
 Reframe – The therapist offers an alternative, typically positive, view of the
presenting problem. This view impacts the cognitions and behavior of the family.
 Prescribing the symptom – The client is directed to perform the symptomatic behavior. If the client follows the directive, he or she is demonstrating control of
the symptom. If he or she resists, they demonstrate he or she can give up the symptom.
 Restraining changes – When the family begins to change, the therapist warns them against changing too fast. This prepares the family for relapse.
 Pretend technique – The identified patient is asked to pretend to have the symptomatic behavior and the other members are asked to pretend to help. This
changes the context and places the symptom under their control.
 Ordeals – The therapist prescribes an ordeal that is equal or greater than the distress of the symptom itself. The task makes it more difficult for the family to have the
symptom than to give it up.
B. Empowerment is a bolstering of the morale of the family. The therapist reframes the therapeutic context and symptom by focusing on the success they have had.
C. Structured interview – The therapist utilizes interview skills to obtain an assessment and diagnosis of the family system.

Question 26

Bowen Family System Therapy

Important Figure

Answer 26

Murrray Bowen

Question 27

Bowen Family System Therapy

Goals of Treatment

Answer 27

A. Decrease anxiety
B. Increase differentiation of self
C. Pay attention to both process and structure
1. Process refers to patterns of emotional reactivity.
2. Structure refers to patterns of interlocking triangles.

Question 28

Bowen Family System Therapy

Key Concepts

Answer 28

A. Differentiation of self
1. Differentiation of self is the cornerstone of Bowen’s theory.
2. It is the ability to maintain a distinction intrapsychically and interpersonally.
 The intrapsychic aspect of differentiation involves a distinction between rational thought and emotionality.
 The interpersonal component refers to the balance between separateness and togetherness.
3. A high level of differentiation denotes the ability to maintain a balance on both these continuums.
4. A low level of differentiation (also referred to as undifferentiation) demonstrates a tendency toward either rationality/emotionality or separateness/togetherness.
B. Triangles
Triangles are the basic building block in a family’s emotional or relational system.
C. Nuclear family emotional system
1. Nuclear family emotional system is the manner in which anxiety is projected from
individuals onto the family.
2. The lower the level of differentiation of the spouses, the higher the amount of
emotional fusion between them.
3. This increased fusion can result in:
 overt marital conflict
 reactive emotional distance
 physical or emotional dysfunction
 projection of problems onto one or more of the children
D. Family Projection Process
E. Emotional cutoff
Emotional cutoff is extreme emotional distance between two individuals. This typically occurs in a marital dyad.
F. Multigenerational transmission process
G. Sibling Position
H. Societal Regressio

Question 29

Bowen Family System Therapy

Techniques

Answer 29

A. Genograms
 Genograms are devices for organizing material regarding one’s family of origin.
 The genogram is a schematic drawing listing family members, relationships, ages, dates of birth, marriages, deaths, and other significant information regarding the
family and relationship dynamics.
B. Process questions
 Process questions are questions that address the patterns of interaction.
 They are designed to decrease the level of reactivity and give the individuals time to think about their participation in the interpersonal patterns.
C. Therapeutic triangle
 Therapeutic triangle is a triangle including the therapist.
 The therapist remains uninvolved emotionally, and discussion is channeled through him/her.
 This technique enables the therapist to decrease the level of anxiety in the session and model a high level of differentiation.

Question 30

Milan Systemic Family Therapy

Important Figures

Answer 30

Mara Selvini-Palazzoli, Luigi Boscolo

Gianfranco Cecchin and Guiliana Prata

Question 31

Milan Systemic Family Therapy

Goals of treatment

Answer 31

A. The rules of the family game are the focus of therapy.
B. A primary goal is to aid the family in making the rules overt and gaining control over them.
C. Although the therapy team may have a goal in mind for the family, the family may create a solution of their own.
D. Another goal is to help the family understand the role of the symptom in its functioning.

Question 32

Milan Systemic Family Therapy

Key concepts

Answer 32

Positive connotation
 Positive connotation is the belief that symptoms serve a logical and purposeful
function within the system.
Family games
 Family games are the organizational patterns around which a family interacts.
 Symptoms may arise when one of these patterns is affecting a family member in a
detrimental manner.

Question 33

Milan Systemic

Other techniques

Answer 33

Positive connotation
 Positive connotation is a reframing of the symptom.
 The therapist attributes positive motives to the symptomatic behavior.
 It is typically stated that the symptom serves the purpose of maintaining the rules
of the family game.
Circular questioning
 Circular questioning is a process of asking questions designed to let clients see
themselves in a relational context and to see that relational context from the
perspective of other family members.
 Questions are structured in a manner that one must give a relational description in
the answer.

Question 34

Cognitve behavioral Family Therapy

Important Figures

Answer 34

A. Major Figures: Albert Ellis  and Aaron Beck
B. Secondary Figures: 
Donald Baucom
Frank Datillio
Norman Epstein

Question 35

Cognitve behavioral Family Therapy

Goals of treatment

Answer 35

A. Rather than focusing on systemic change, the goal of CBFT is to eliminate undesirable behavior and increase positive behavior.
B. The family determines the desired change, typically in the form of a presenting problem.
C. The therapist empowers the family to solve their own problems through education and assistance via increased understanding.
D. Focus on cognitions occurs as the therapist teaches the family that emotional problems are caused by irrational beliefs and that by changing these distortions overall quality of life will improve.

Question 36

Cognitve behavioral Family Therapy

Behavioral

Answer 36

1. Operant responses (causes)
    Operant responses (causes) are responses not automatically elicited by stimuli.
    Their occurrence is affected by their consequences.
2. Respondent responses (effects)
    Respondent responses (effects) are those under the control of stimuli.
    Their consequences do not affect the frequency of occurrence.

Question 37

Cognitve behavioral Family Therapy

Reinforcements

Answer 37

Reinforcements are consequences that affect the rate of behavior, either accelerating or decelerating it.
a. Reinforcers are consequences that accelerate behavior.
 Negative reinforcers are aversive consequences.
 Positive reinforcers are rewarding consequences.
b. Punishers are consequences that decelerate behavior.
 Aversive control is the implementation of a negative reinforcer such as spanking.
 Withdrawal of positive consequences refers to the absence of positive
reinforcers.

Question 38

Cognitve behavioral Family Therapy

Extinction

Answer 38

 Extinction occurs when no reinforcement follows a response.
 The cessation is not immediate.

Question 39

Cognitve behavioral Family Therapy

The theory of social exchange

Answer 39

 The Theory of Social Exchange says that people maximize profits and minimize costs.
 In a functional relationship, the individual partners attempt to maximize a rewarding relationship.
 In a dysfunctional relationship, both partners focus on self-protection rather than maximizing the happiness of their partner.

Question 40

Cognitve behavioral Family Therapy

Techniques

Answer 40

A. Operant Techniques
1. Shaping
 Shaping occurs when there is a deliberate attempt to create a new response.
2. Contingency contracts
 Contingency Contracts involve the parents agreeing to make certain changes if a child makes certain agreed upon changes.
3. Contingency management
 Contingency management consists in giving or taking away rewards or punishments based on the behavior of the child.
4. Token economies
 Token economies utilize a system of stars or points to reward a child for successful behavior.
5. Time out
 Time out is a punishment in which a child must sit in a corner or a room for a specified length of time.
B. Respondent conditioning
 Respondent conditioning involves modification of physiological responses.
 This can include desensitization, assertiveness training, aversion, and sex therapy.
C. Cognitive affective techniques
1. Thought-stopping
 Thought-stopping involves the raising of awareness of automatic thoughts with the intent of gaining control over them.
 The client is taught methods to replace these automatic thoughts with more balanced cognitions.
2. Rational emotional emphasis
 Rational emotional emphasis is to help family members see how illogical beliefs and distortions serve as the foundation of their emotional distress.
 As the individual addresses these distortions, the emotional intensity with which they deal will decrease.

Question 41

Brief solution focused family therapy

Important Figures

Answer 41

A. Major Figures: Steve deShazer Insoo Berg
B. Secondary Figures: Eve Lipchik Michelle Weiner-Davis
Bill O’Hanlon John Walter and Jane Peller

Question 42

Brief solution focused family therapy

Goals of treatment

Answer 42

A. The goal of solution-focused therapy is to help clients resolve their complaint by helping them change their focus.
B. This leads to a different perspective and a greater level of satisfaction with their lives.
C. The therapist believes that this perspective becomes apparent once clients begin moving toward their desired goal.
D. It is necessary, therefore, for a goal or goals to be determined early in therapy.

Question 43

Brief solution focused family therapy

Question

Answer 43

1. The Miracle Question
    The Miracle Question is a question asked for the purpose of clarifying the goal(s) the client wants to achieve.
    The client is asked to imagine that while he/she was sleeping a miracle happened and the problem was solved.
    The client is asked to describe what would be different?
2. Scaling Questions
    Scaling Questions aid in clarification of ambiguous goals or feelings.
    An example is “on a scale of one to ten with one being the way you felt when you called and ten being the way you would feel after the miracle, how do you feel
   right now?”
    “What would move you from a 2 to a 3?”
3. Coping Questions
    Coping Questions focus on the strengths of the client.
    The therapist asks the client what he/she has done to be able to cope with the problem.
    As the client answers, the therapist is noting the strengths the client describes.

Question 44

Narrative Family Therapy

Important Figures

Answer 44

A. Important Figures: Michael White and David Epston

B. Secondary Figures: Alan Parry and Robert Doan

Question 45

Narrative Family Therapy

Goals of treatment

Answer 45

A. The goal of therapy is to enable people to write a new story that emphasizes their preferred ways of relating to themselves and to others.
B. This is accomplished by removing the problem from their identity through externalization of the problem.
C. A new story is authored through deconstruction of the problem-saturated story and reconstruction of a new narrative.