Wk 10 - Systemic/ Family Therapy

Question 1

What are the 2 main types of family therapy?

Answer 1

1) Satir Family Therapy (human validation process)

2) Structural Family Therapy

Question 2

What is the key assumption of the Satir Family Therapy?

Answer 2

Humanistic Assumption

• Connection with the client
• Focus on client’s Self-esteem
• Create a validating environment for clients
• Believes that people have the resources to flourish within them

Question 3

What are the 4 key ideas of Satir Family therapy?

Answer 3

1) Self-Esteem
2) Communication & Metacommunication
3) Primary Triad
4) Family Rules

Question 4

What does Satir Family Therapy posit about self-esteem?

Answer 4

1) Self-esteem is defined as the degree to which the individual values himself regardless of the opinions of others
2) Self-esteem is the product of early family experiences. Parents with good self-esteem can teach what they already know. Parents with a shakey sense of self-worth cannot teach what they dont have.
3) Self esteem is important because loving the self is a precondition for loving others

Question 5

What does Satir means by congruent communications?

Answer 5

Verbal outward expression (thoughts) and nonverbal inner emotions (feelings) must be the same.

Question 6

What does Satir mean by metacommunications?

Answer 6

Meta communications refer to implicit meanings in our speech and non verbal behavior. The therapist helps families realise how their incongruent communications maintain their relational difficulties. With this awareness, the family can work together to think of more congruent and helpful ways of communicating.

Question 7

What is the primary triad? What does the child learn from the primary triad?

Answer 7

• relationship between father-mother-child. this relationship is the most important influence on an individual’s life functioning.
• learns about his/her own self-worth and self-efficacy, how to cope with the world, the nature of relationships, and how to understand communication
• if child feels excluded from the parental dyad, and are being rejected, they are likely to develop low self-worth
• if all 3 parties have good self-esteem, they can work together to use the resources in the relationship

Question 8

How is family rules related to self-esteem? What are the characteristics of family rules?

Answer 8

When family rules are impossible to meet, they contribute to poor self-esteem.

• Family rules can be overt or covert (unspoken rules)
• Family rules should be flexible and age appropriate
• Family rules should allow for members to operate independently in the world and share information freely

Question 9

What are the 3 different kinds of communications?

Answer 9

1) functional communication - clear, complete, assertive
2) congruent communication - verbal and nonverbal messages match
3) metacommunication - communicdation about communication

Question 10

What are the 4 dysfunctional and problematic communication patterns?

Answer 10

1) placating - yes man, people pleaser
2) blaming - loud and bossy
3) computing - little feeling and analyses everything
4) irrelevant - distracted from conversation

Question 11

Why do people engage in problematic communication patterns?

Answer 11

To cope with and hide vulnerability of poor self-esteem

Question 12

What is considered health and dysfunction in Satir family therapy?

Answer 12

Health
- coherent and congruent communication patterns (free and honest)
- healthy self-esteem is promoted
- able to love and be loved
Dysfunction
- dysfunctional communication patterns to cope with underlying low self-esteem (placating, blaming, computing, irrelevant)

Question 13

What are the 3 steps for assessment in Satir Family Therapy?

Answer 13

1) Observe communication patterns in family sessions
2) Assess self-esteem of family members
3) Identify family rules based on behaviors of members

Question 14

What are 2 main goals of Satir Family Therapy?

Answer 14

1) improve self-esteem of family members

2) reduce problematic communication patterns. help the family communicate more clearly and freely.

Question 15

What are 2 key techniques of Satir Family Therapy?

Answer 15

1) Family sculpting

2) Relating to parts of ourselves

Question 16

Describe the self mandala.

Answer 16

Human essence has 8 aspects. No aspect should be neglected in order to maintain an individual’s health.

• body
• soul
• thoughts
• feelings
• senses
• relationships
• context
• nutrition

Question 17

Describe healthy and nurturing families.

Answer 17

1) open communication
2) strong individual self-worth
3) flexible and humane family rules
4) congruent communication
5) family’s connection to society is open and hopeful

Question 18

Describe dysfunctional/troubled families.

Answer 18

1) fuzzy communicaiton
2) self-esteem in members are low
3) family is fearful in relationship to society (eg. can be blaming or placating in response)
4) family rules are rigid and inhumane
5) family members are not friends

Question 19

Provide an overview of the 3 stages of Satir Family therapy.

Answer 19

Stage 1) Contact
Stage 2) Chaos
Stage 3) Integration

Question 20

Satir family therapy emphasizes the process of therapy over its content. What does this mean?

Answer 20

WHAT they are actually arguing about is less important than HOW they are doing it.

Question 21

Describe Stage 1 - Contact.

Answer 21

• therapist creates an atmosophere of hope and trust. acknowledges every member of the family
• therapist gathers information by observing family patterns
• therapist will make explicit what family members often know implicitly

Question 22

Describe Stage 2 - Chaos

Answer 22

• occurs when a family member ventures into risky territory

- therapist helps family to stay in the present and support the family members if necessary

Question 23

Describe Stage 3 - Integration.

Answer 23

• Therapist and family finds a way to move past the issue

- Family develops new ways of relating to each other and gain some closure

Question 24

What are the 4 main techniques used in Satir’s family therapy?

Answer 24

1) Family Sculpting
2) Communication Analysis
3) Therapist communication
4) Family Thermometer

Question 25

Describe the Family Sculpting technique.

Answer 25

• Family members physically take positions that exemplify the family’s interactions
• Physically take poses reflective of the communication types
• Visually illustrate relationship dynamics and power dynamics
• therapist then directs questions to the various members. Aim is to explore thoughts and feelings about the situation that is sculpted
  “what are you feeling right now? What body sensations do you have? can you exaggerate your movement?”

Question 26

Describe the Communication Analysis technique

Answer 26

Create experiences that promotes healthy communication. Family members are encouraged to express their feelings and respect these communications.

Question 27

Describe Therapist Communication technique

Answer 27

Therapist will reframe things to help families view things in a different light

Question 28

Describe the Family Thermometer technique

Answer 28

5 themes - appreciation, negatives of life, puzzles, new information, hopes and wishes
family members give opinions on where the family is on each theme and are encouraged to physically construct the thermometer and hang it at home to remind them to periodically take readings on each theme.

Question 29

Describe the technique of getting family members to relate to parts of themselves.

Answer 29

Encourages the communication of internal pain and externalizing of emotions so that they can be accepted. Can draw on other family members to validate that individual

Question 30

What are the 2 assumptions of Structural Family Therapy?

Answer 30

1) Family structures determines how family members should relate to one another. Family structures can be healthy or dysfunctional.
2) Renegotiation of subsystems at critical family developmental stages can be stressful (eg. getting married, having young children, adolescent children etc.)

Question 31

According to Structural Family Therapy, what is considered a healthy family structure?

Answer 31

Healthy

• structure is clearly defined and flexible (2 parents up there on the hierarchy, parents relate to children, siblings relate to each other)
• individual is differentiated (children can individuate)
• different subsystems are functioning

Question 32

According to Structural Family Therapy, what is considered a dysfunctional family structure?

Answer 32

• Presence of Coalitions and alignment between one parent and one child against another parent (eg. mother pair up with son against father)
• boundaries are too rigid (disengaged) or blurred (enmeshed) and cannot adapt to the current circumstances of the family

Question 33

What are the two key ideas of structural family therapy?

Answer 33

1) subsystems

2) boundaries

Question 34

Subsystems can be distinguished along what lines?

Answer 34

Gender, generation, functional

eg. partner, parents, siblings, individual

Question 35

What are the 2 different types of boundaries in the family?

Answer 35

1) enmeshed/blurred - boundaries not clear (creates inappropriate roles, can result in lack of independence and autonomy in children. immediate transmission of stress to the entire family)
2) disengaged/rigid - boundaries are too rigid (creates isolation, as other members fail to provide support and help to each other)

Question 36

Describe the 4 step process of structural family therapy.

Answer 36

1) reframe the problem as systemic
2) highlight the interactions that maintain the problem (circular causality) - clarifying what the family does to maintain the problem, especially how the interactions support the problem
3) explore unhelpful structures learnt from past experiences (adults will look at how their experiences have shaped their present views of themselves and others)
4) highlight alternative ways of relating

Question 37

What are the 7 different techniques used in structural family therapy?

Answer 37

1) Enactment/’tracking’ the circular causality
2) Reframing
3) Focusing
4) Achieving intensity
5) Boundary making
6) Unbalancing
7) Directives

Question 38

How does the therapist do enactment and ‘track’ the problem/circular causality?

Answer 38

Get clients to perform their roles in session to help you get a better sense of what is happening at home and assessing family structure. Observing how parents interact with children provides valuable info about how the parental and kid subsystems operate.

Question 39

How does the therapist do the reframing technique?

Answer 39

1) Challenge the family’s view of the problem. Instead of blaming it on an individual, frame it as a systemic issue. 2) Reframe using positive connotations (Eg. attention seeking –> attention needing)
3) Change from narrow and negative perspective to a more positive and flexible one

Question 40

How does the therapist do the focusing technique?

Answer 40

There are many different problems in a family so focus on one problem at a time.

Question 41

How does the therapist do the achieving intensity technique?

Answer 41

1) repetition - therapist’s message is repeated multiple times in session so that it is registered
2) interaction of family is encouraged beyond the point that it usually stops. sometimes the situation gets too hot and the interaction is discontinued. therapist will ask participants to hang in there, and journey into this new territory. this has potential to create new patterns of relating.
3) therapist physically approaches family member for emphasis to get a point across

Question 42

How does the therapist do boundary making? (2)

Answer 42

1) not allowing family members to answer questions for each other
2) change seating arrangements to break up alliances

Question 43

How does the therapist do unbalancing?

Answer 43

Change the hierarchy of the family. Therapist may side with less powerful subsystems to balance power, and may ignore certain more powerful subsystems. Note that this should be done with care.

Question 44

How should the therapist use directives?

Answer 44

use direct instructions when clients are compliant. can be direct or paradoxical.

Question 45

Across family therapies, what are some general ideas? (4)

Answer 45

1) the family is interconnected
2) circular causality
3) open vs closed systems
4) homeostasis

Question 46

What does it mean when we say that the family is interconnected?

Answer 46

influences on one part of the system will affect other parts. we need to see individuals in a context and focus on relationships among individuals in the system.

Question 47

Describe the idea of circular causality.

Answer 47

The system as an interlocking chain of events.

eg. event A and B are mutually reinforcing each other

Question 48

Describe open vs closed systems.

Answer 48

open systems - information flows in and out easily
closed systems - information doesn’t flow in and out easily. impermeability leads to rigidity and thus inability to change and adjust with the environment

Question 49

Describe the idea of homeostasis.

Answer 49

Systems tend to self-regulate and are therefore resistant to change. Hence, we cannot just change one member in isolation, because when he/she returns to the system, the system will attempt to get him/her to change back.

Question 50

In Satir’s approach, what is the therapist like?

Answer 50

• warm, accepting of herself, authentic
• nonjudgmental and genuine
• resource person and expert

Question 51

What are the types of alignments found in dysfunctional families?

Answer 51

1) scapegoating - parents who are in conflict channel their stress to the child, who then develops symptoms. parents perpetuate and reinforce the symptoms.
2) triangulation - parents are openly split. child is put in the middle, persecuted if a side is taken.

Question 52

In Structural Family Therapy, what is the therapist like?

Answer 52

Joining as a member & leader of the system

- therapist is in the same boat but is the helmsman. supports family members and work with them.