Family Therapy Flashcards
(141 cards)
1
Q
Key figures in family therapy
A
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).
2
Q
Nonsummativity
(Page 359).
A
– 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).
3
Q
Boundaries
(Page 359).
A
the borders that separate a family system from other systems. This makes the family a distinct entity.
(Page 359).
4
Q
Circular causality
(Page 359).
A
replaces linear cause and effect.
(Page 359).
5
Q
Equifinality
(Page 359).
A
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).
6
Q
Characteristics of a Healthy Couple (Becvar &Becvar, 1996)
Attitudes and Beliefs
(Page 360).
A
- 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).
7
Q
Characteristics of a Healthy Couple (Becvar &Becvar, 1996)
Behavior Patterns
A
- 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).
8
Q
Characteristics of a Healthy Family as Listed by Becvar and Becvar (1996):
(Page 361).
A
- 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).
9
Q
Life Stage Cycles: Early stages: Forming and nesting
(Page 361).
A
- 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).
10
Q
Life Stage Cycles: Middle stages: Family separation process
(Page 361).
A
- 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).
11
Q
Life Stage Cycles: Last stages: Finishing
(Page 361).
A
- 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).
12
Q
Psychodynamic Family Therapy (key figures)
A
Important Figures: David Scharff
Jill Scharff
Secondary Figures: Nathan Ackerman James Framo Robin Skynner Melanie Klein Samuel Slipp
(Page 363).
13
Q
Goal of Psychodynamic Family Therapy
A
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).
14
Q
Object relations theory
(Page 365).
A
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).
15
Q
Splitting
(Page 365).
A
to children separating their internal world into good and bad aspects. This is an evolving process consistent with their developmental stage.
(Page 365).
16
Q
Four phases of development in object relations:
(Page 365).
A
- 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).
17
Q
Transference
(Page 365).
A
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).
18
Q
Countertransference
(Page 365).
A
the reciprocal interaction of the other person in the face of transference.
(Page 365).
19
Q
Internal objects
(Page 365).
A
mental images of the self and others built from experience and expectation.
(Page 365).
20
Q
Introjection
(Page 365).
A
“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).
21
Q
Identification
(Page 365).
A
involves the internalization of a role. The child takes on certain roles and behaves as his/her parents did.
(Page 365).
22
Q
Ego identity
(Page 365).
A
is a synthesis of identifications and introjections. It provides a sense of coherence and continuity.
(Page 365).
23
Q
Holding environment
(Page 365).
A
emphasizes the need for closeness yet separateness in order to achieve whole object relations.
(Page 365).
24
Q
Transitional objects
(Page 365).
A
neither self nor object yet are treated as if they were the beloved parent and the self.
(Page 365).
25
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).
26
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).
27
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).
28
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).
29
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).
30
The 7 mutually reinforcing functions:
(Satir's Experiential)
(Page 368).
1. To provide a sexual experience for the mates
2. To contribute to the continuity of the race by producing and nurturing children
3. 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
4. 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
6. To recognize when one of the members is no longer a child but has become an adult capable of performing adult roles and functions
7. To provide for the eventual care of parents by their children
(Page 368).
31
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).
32
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).
33
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).
34
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).
35
Reframing
(techniques Satir)
(Page 370).
reinterpretation of problems in order to shift the perspective of the client system.
(Page 370).
36
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).
37
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).
38
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).
39
Multiple family therapy
(techniques Satir)
(Page 370).
therapy with several unrelated family systems.
(Page 370).
40
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).
41
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).
42
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).
43
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).
44
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).
45
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).
46
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).
47
Phases of therapy (Whitaker's Experiential)
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.
(Page 373).
48
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).
49
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).
50
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).
51
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).
52
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).
53
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).
54
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).
55
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).
56
Accommodation
(Structural technique)
(Page 378).
when the therapist modifies their language, tone, or style in order to join with the client.
(Page 378).
57
Maintenance
(Structural techniques)
(Page 378).
the act of the therapist focusing or highlighting certain behaviors in order to increase the functional aspects of the family structure.
(Page 378).
58
Tracking
(Structural techniques)
(Page 378).
the use of clarification or amplification of communication to reinforce individuals or subsystems.
(Page 378).
59
Mimesis
(structural techniques)
(Page 378).
the adoption of the clients’ communication style by the therapist.
(Page 378).
60
Restructuring techniques
(Structural techniques)
(Page 378).
techniques that directly impact the family structure.
(Page 378).
61
```
Structural map
(Structural techniques)
```
(Page 378).
a symbolic representation of a family’s structure. It places emphasis on boundaries and coalitions.
(Page 378).
62
Enactment
(Structural techniques)
(Page 378).
when the therapist directs the family to perform an interaction. It can be directly related to the presenting problem or be more benign.
(Page 378).
63
Escalation of stress
(Structural techniques)
(Page 378).
is the heightening of tension in the family in order to force the members to accept the restructuring.
(Page 378).
64
Boundary making
(Structural techniques)
(Page 378).
takes place as the therapist assists the family in setting new boundary rules, renegotiating old rules, or establishing specific functions for each subsystem.
(Page 378).
65
Utilizing the symptom
(Structural techniques)
(Page 378).
occurs when the therapist changes the function of the symptom in the family by encouraging, de-emphasizing, or relabeling it.
(Page 378).
66
Mood manipulation
(Structural techniques)
(Page 378).
occurs as the therapist attempts to change the mood or pacing of the family in order to bring more energy to the session or lead the family to a more reflective frame of mind.
(Page 378).
67
Support, education, and guidance
(Structural techniques)
(Page 378).
takes place as the therapist provides instruction to the family for various presented needs.
(Page 378).
68
STRATEGIC FAMILY THERAPY
(Key figures)
(Page 379).
Jay Haley and Cloe Madanes
(Page 379).
69
Overview – Strategic
(Page 379).
A. Strategic family therapy views families as rule-governed systems.
B. Symptoms are believed to be maintained by the system and, likewise, to maintain the system.
C. The family is prevented from achieving its purpose as a family by ongoing destructive cycles of interaction.
(Page 379).
70
Goal of Treatment – Strategic
(Page 379).
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.
(Page 379).
71
Role of the Counselor – Strategic
(Page 379).
A. The therapist is neutral, directive, and in control of the session.
B. They take on the role of an expert.
C. They maintain focus on the problem.
D. The therapist provides a supportive yet challenging environment.
(Page 379).
72
Role of the Symptom – Strategic
(Page 379).
A. Symptoms serve the purpose of maintaining the family system.
B. The symptom is a strategy used for controlling a relationship when other strategies have failed.
C. Vying for control is seen as inevitable.
D. It becomes pathological only when one or both partners deny their attempts to control.
(Page 379).
73
Normal Family Development – Strategic
(Page 380).
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.
(Page 380).
74
Development of Behavioral Disorders
(Strategic)
(Page 380).
A. Hierarchical structure is unclear or inappropriate.
B. Problems are addressed at an inappropriate level in the hierarchy.
C. Families either deny a problem exists or create a problem where none exists.
(Page 380).
75
Key Concepts and Terminology
(Strategic)
(Page 380).
A. Hierarchy is the decision-making structure of a family. It is based on age, gender, roles, or education.
B. Alliances and coalitions are formed by the joining of two family members against a third. This typically disrupts the family hierarchy by placing a child in a parental role.
C. Communication – two levels of communication:
1. Digital communication is content-focused communication. This communication is rigid and is typically transmitted to one referent. Difficulty occurs when only digital communication is accepted as relevant without taking other forms of communication into consideration.
2. Analogic communication is communication that is conveyed through body language and symbolism. The therapist must have an understanding of this form of communication among individuals in order to view the problem within a relational context.
D. Symptoms are patterns of family interaction that have become problematic within the system. They are the root of the concern that brings the family into therapy.
E. Presenting problem is the problem stated by the family that brings them in for therapy.
F. Power refers to the struggle to be in control and to make the rules of the family.
(Page 380).
76
Directives
| Strategic techniques
Directives are assignments given by the therapist to be performed between sessions. They are a key intervention and are either straightforward or paradoxical.
(Page 381).
77
straightforward directives
| Strategic techniques
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.
(Page 381).
78
```
Paradoxical directives
(Strategic techniques)
```
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.
(Page 381).
79
Empowerment
(Strategic techniques)
(Page 381).
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.
(Page 381).
80
Structured interview
(Page 381).
The therapist utilizes interview skills to obtain an assessment and diagnosis of the family system.
(Page 381).
81
BOWEN FAMILY SYSTEMS THERAPY
Key figures
(Page 382).
A. Major Figure: Murray Bowen
B. Secondary Figures: Thomas Fogarty; Edwin Friedman; Philip Guerin; Michael Kerr
(Page 382).
82
Overview – Bowen’s Model
(Page 382).
A. Bowen believes the main dysfunction manifested in troubled families is emotional fusion. Although people need togetherness, emotional fusion is an exaggeration of this need.
B. The goal of therapy is a high level of differentiation of self. A person with a high level of differentiation is able to be close to others but maintain a healthy autonomy.
(Page 382).
83
Goals of Treatment – Bowen’s Model
(Page 382).
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.
(Page 382).
84
Role of the Counselor – Bowen’s Model
(Page 382).
A. Coach, researcher, active expert
B. The counselor becomes the third side of a therapeutic triangle
C. Works most often with the parental dyad
(Page 382).
85
Role of the Symptom – Bowen’s Model
(Page 382).
A. The symptom will typically identify the most vulnerable person in a triangle.
B. The therapist will utilize this knowledge to identify the participants in the triangle and, beginning with the individual with the highest level of differentiation, work to aid the family in increasing their levels of differentiation.
(Page 382).
86
Normal Family Development – Bowen’s Model
(Page 383).
A. Family members have a high level of differentiation. B. Anxiety in the family is low.
C. Parents have differentiated from their own families of origin.
(Page 383).
87
Development of Behavioral Disorders
(Bowen)
(Page 383).
A. The higher the level of differentiation, the greater the flexibility and resilience in dealing with stress. The lower the level of differentiation, the less stress needed to provoke symptoms.
B. In order to stabilize the stress-filled system, triangulation occurs.
- If the third party remains neutral, the anxiety lessens and symptoms lessen.
- If the individual becomes emotionally involved, however, the likelihood of symptom development increases.
- The most vulnerable person in the triangle (typically a child) is most likely to develop symptoms and be the focus of conflict.
(Page 383).
88
Differentiation of self
(Bowen)
(Page 384).
- 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.
- A high level of differentiation denotes the ability to maintain a balance on both these continuums.
- A low level of differentiation (also referred to as undifferentiation) demonstrates a tendency toward either rationality/emotionality or separateness/togetherness.
(Page 384).
89
Triangles
(Bowen)
(Page 384).
1. Triangles are the basic building block in a family’s emotional or relational system.
2. During periods when anxiety is low and external conditions are calm, a two-person system will engage in direct communication.
3. When tension mounts, one or both persons will pull in a third person in order to reestablish stability.
4. The triangle dilutes the anxiety, is more stable and flexible than a twosome, and has higher tolerance for stress.
5. Triangles are typically interlocking and involve an increasing number of people as tension mounts.
(Page 384).
90
Nuclear family emotional system
(Bowen)
(Page 384).
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
(Page 384).
91
Family projection process
(Bowen)
(Page 385).
1. Family projection process refers to the manner by which parents transmit their dysfunction to their children.
2. This transmission of undifferentiation occurs through the triangulation of the most vulnerable child or children.
(Page 385).
92
Emotional cutoff
(Bowen)
(Page 385).
1. Emotional cutoff is extreme emotional distance between two individuals. This typically occurs in a marital dyad.
2. It can also accompany physical cutoff as a child attempts to deal with unresolved emotional fusion with the family of origin.
(Page 385).
93
Multigenerational transmission process
(Bowen)
(Page 385).
1. Multigenerational transmission process describes the process by which severe dysfunction is a result of decreasing degrees of differentiation over several generations.
2. As an individual chooses a spouse with a similar level of differentiation and family projection process occurs, the child will attain a lower level of differentiation.
(Page 385).
94
Sibling position
(Bowen)
(Page 385).
1. Sibling position refers to Bowen’s belief that children develop fixed personality characteristics based on their sibling position in their family of origin.
2. These characteristics will be played out in their marriage in relation to the spouse’s birth order.
(Page 385).
95
Societal regression
(Bowen)
(Page 385).
1. Societal regression suggests that the emotional process of society impacts the emotional process of the family.
2. As society at large becomes more anxiety ridden, the result is isomorphic with that of the family leading to lower levels of differentiation.
(Page 385).
96
Techniques – Bowen’s Model
(Page 386).
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.
(Page 386).
97
MILAN SYSTEMIC FAMILY THERAPY
(key figures)
(Page 387).
Milan group: Mara Selvini-Palazzoli; Luigi Boscolo; Gianfranco Cecchin; Guiliana Prata
(Page 387).
98
Overview – Milan Systemic
(Page 387).
A. The model is systemic in nature and views patterns of interaction as being handed down from one generation to the next.
B. The change process is viewed as important with the family being given a long time between sessions in order to attain the maximum amount of change.
C. Change of behavior as well as cognition is the focus of therapy.
(Page 387).
99
Goals of Treatment – Milan Systemic
(Page 387).
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.
(Page 387).
100
Role of the Counselor – Milan Systemic
(Page 387).
A. The therapist is a participant in the family system.
B. The therapist views the relationship as recursive in that he/she impacts the family as the family impacts him/her.
C. Three aspects of the therapist’s role:
1. Neutrality
2. Promoting change through prescriptions to change the rules of the family game
3. Making the rules of the game overt
D. Although the therapist maintains control of the session, he/she should attempt to avoid imposing his/her expert perspective on the client.
E. The style is nonconfrontational and typically involves a team approach.
(Page 387).
101
Role of the Symptom – Milan Systemic
(Page 388).
A. A family member, usually a child, will manifest a symptom in order to protect some of the family members.
B. It is believed that the symptom serves a function in the system and that the family organizes itself around this symptom.
C. The symptom is a key to determining the rules of the family game.
(Page 388).
102
Normal Family Development – Milan Systemic
(Page 388).
A. The Milan group has placed minimal emphasis on healthy families and tries to avoid applying preconceived models to families.
B. They do, however, appear to believe that families should have clear generational boundaries.
(Page 388).
103
Development of Behavioral Disorders
(Milan Systemic)
(Page 388).
A. The family game demonstrates the dysfunction of the family.
B. The game can involve extended family members and take place over a long timeframe.
C. There are power alliances, typically across generations, that make up the rules of the game and maintain it.
(Page 388).
104
Key Concepts and Terminology
(Milan Systemic)
(Page 389).
A. Circularity: Circularity refers to the recursive nature of living systems.
- This concept was the underlying foundation for neutrality, hypothesizing, and circular questioning.
B. Hypotheses: Hypotheses are explanations offered by the team regarding the role of the symptom in the family and how the family organizes around it.
C. Significant system: Significant system refers to the system that is organized around the presenting problem.
- This can involve the family, the school, friends, etc. D. Positive connotation: Positive connotation is the belief that symptoms serve a logical and purposeful function within the system.
E. 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.
F. Alliances: Alliances are connections between two individuals that may exclude a third.
- These alliances can be healthy (as in two parents) or pathological (a parent and a child).
(Page 389).
105
Techniques – Milan Systemic
(Page 390).
1. Telephone interview
2. Pre-session meeting: Pre-session meeting of the team in order to formulate initial hypotheses.
3. SESSION 1 : Session 1 involves an interview of the extended family and friends while the team observes.
- Both the therapist and team gather information regarding the rules of the family game.
- The therapeutic system takes a break in order for the team to revise its hypothesis and prepare the prescription.
- The prescription is given to the family in the form of a positive connotation.
4. SESSION 2: Session 2 involves only the nuclear family.
- Changes in the family are recognized and assessment occurs on issues more specific to the nuclear family.
- This session involves: a. a connecting phase b. an analysis phase c. a testing phase
5. SESSION 3: Session 3 focuses on the parents alone.
- Assessment continues, and the team gives the parents a prescription for change.
6. SESSION 4: Session 4 through the final session focuses on reviewing parental observations regarding the prescription and addressing responses to additional prescriptions provided by the team.
(Page 390).
106
COGNITIVE BEHAVIORAL FAMILY THERAPY
Key figures
(Page 392).
A. Major Figures: Albert Ellis; Aaron Beck
B. Secondary Figures: Donald Baucom; Frank Datillio; Norman Epstein
(Page 392).
107
Overview – Cognitive Behavioral
(Page 392).
A. Cognitive-Behavioral Family Therapy is based on behavioral therapy that teaches the concepts of classical conditioning and operant conditioning.
B. Operant conditioning is suited for families in that it addresses reinforcement.
C. Operant conditioning espouses that behaviors that are positively reinforced will be repeated and behaviors that are punished or ignored will be extinguished.
D. CBFT is based on the premise that behavior is maintained by its consequences.
(Page 392).
108
Goals of Treatment – Cognitive Behavioral
(Page 392).
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.
(Page 392).
109
Role of the Counselor – Cognitive Behavioral
(Page 392).
A. The therapist takes on a directive role as the expert on behavior and cognitions. The therapist models appropriate behavioral strategies for communication and conflict resolution.
B. Another task the therapist acquires is that of assessing the cognitive distortions of the client and educating them on more appropriate ways to handle their thought processes.
(Page 392).
110
Role of the Symptom – Cognitive Behavioral
(Page 393).
Symptoms are considered to be learned responses. They are involuntarily acquired and reinforced. The symptoms are the focus of therapy. They lead to the responses of the family members that reinforce the symptomatic behavior.
(Page 393).
111
Normal Family Development
(CBFT)
(Page 393).
A. The focus of Behavioral theorists is on the current behavior.
B. Little attention is given to past development, either normal or dysfunctional.
C. A good relationship is viewed as having a balance of give and take.
D. There is an exchange of pleasant behavior and minimal unpleasant behavior.
E. Communication skills are considered to be the most important feature of good relationships.
F. Conflict resolution is also deemed vital to the maintenance of healthy relationships.
G. Family schemata, as taught by the parents’ families of origin, are applied to the marriage and to the rearing of children.
(Page 393).
112
Development of Behavioral Disorders
(CBFT)
(Page 393).
A. Behavioral disorders develop as a result of reinforcement by family members.
B. Illogical beliefs and distortions are the foundation of emotional distress.
C. Four means by which a family’s cognitions, behavior, and emotions may interact and build a volatile climate: 1. The individual’s own cognitions, behavior, and emotion regarding family interaction
2. The actions of individual family members towards him or her
3. The combined reactions several family members have toward him or her
4. The characteristics of the relationships among other family members
(Page 393).
113
Key Concepts and Terminology
(CBFT)
(Page 394).
A. Behavioral
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.
3. Reinforcements: 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.
4. Extinction: Extinction occurs when no reinforcement follows a response.
- The cessation is not immediate.
5. The Theory of Social Exchange: 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.
B. The Cognitive-Behavioral approach: balances an emphasis on cognitions and behavior.
1. Family relationships, cognitions, emotions, and behavior are believed to exert mutual influence on each other.
- Members of a family influence and are influenced by each other.
2. Family schemata are beliefs the family members have about the family.
a. The beliefs are formed through years of interaction among the different members.
b. Two separate sets of schemata are maintained:
- Beliefs regarding family of origin
- Beliefs about families in general
(Page 394).
114
Operant Techniques – Cognitive Behavioral
(Page 395).
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.
(Page 395).
115
Respondent conditioning techniques - Cognitive Behavioral
- Respondent conditioning involves modification of physiological responses.
- This can include desensitization, assertiveness training, aversion, and sex therapy.
(Page 395).
116
Cognitive affective techniques
(CBFT)
(Page 395).
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.
(Page 395).
117
BRIEF SOLUTION FOCUSED FAMILY THERAPY
Key figures
(Page 396).
A. Major Figures: Steve deShazer; Insoo Berg
B. Secondary Figures: Eve Lipchik; Michelle Weiner-Davis; Bill O’Hanlon; John Walter; Jane Peller
(Page 396).
118
Overview – Brief Solution Focused
(Page 396).
A. The solution-focused model is based on the belief that when the focus is drawn to exceptions or solutions to problems, change is more likely.
B. Problem cause is de-emphasized, and therapy tends to be brief and goal-focused.
(Page 396).
119
Goals of Treatment – Brief Solution Focused
(Page 396).
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.
(Page 396).
120
Role of the Counselor – Brief Solution Focused
(Page 396).
A. The therapist is viewed as a partner in the therapeutic process.
B. Although he/she is directive regarding the shift in focus, the family is viewed as the experts of their situation.
C. The therapist emphasizes exceptions and solutions in a warm and caring manner.
D. Change is expected, and therapy is brief.
(Page 396).
121
Role of the Symptom – Brief Solution Focused
(Page 397).
A. The symptom or complaint is what brings the family to therapy.
B. It is used to enable the family to focus on when the complaint does not occur and the times the family is successful.
C. Although the symptom may be incorporated into the goal formulation, it is de-emphasized as the family shifts their focus to solutions.
(Page 397).
122
Normal Family Development
( brief therapy)
(Page 397).
A. Families are not viewed as functional or dysfunctional.
B. Through his/her belief in multiple realities, the therapist does not want to impose his/her perspective of what is normal.
C. The therapist is interested in language and the way language is utilized to provide a description of the complaint.
(Page 397).
123
Development of Behavioral Disorders
(brief therapy)
(Page 397).
A. As is consistent with the solution focus of therapy, therapists themselves focus on how families are effective rather than on what they are doing wrong.
B. Solutions to problems are viewed as separate from problem formation.
C. It is, therefore, unnecessary to try to determine causality.
(Page 397).
124
NARRATIVE FAMILY THERAPY
Key figures
(Page 400).
A. Important Figures: Michael White; David Epston
B. Secondary Figures: Alan Parry; Robert Doan
(Page 400).
125
Overview – Narrative
(Page 400).
A. Narrative family therapy comes from a social constructionist perspective.
B. It utilizes the metaphor of a narrative to help clients understand that they can overcome the problem-saturated story of their lives and embrace a new story. C. The importance of language is stressed and clients are shown how language can oppress or liberate an individual through the process of therapy.
(Page 400).
126
Goals of Treatment – Narrative
(Page 400).
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.
(Page 400).
127
Role of the Counselor – Narrative
(Page 400).
A. The therapist has a collaborative stance and views the family as having expertise regarding their story.
B. The role of the counselor, therefore, is that of an editor or publisher.
C. The counselor has expertise in drawing out the story of the client and helping him/her to reauthor that story.
(Page 400).
128
Role of the Symptom – Narrative
(Page 401).
A. The symptomatic behavior is based on a belief in the reality of the problem-saturated story.
B. As long as the client accepts an identity based on this story, he/she will act accordingly.
C. When his/her perspective of himself/herself changes to a more positive frame, he/she is free to act in a manner that does not include the problem.
(Page 401).
129
Normal Family Development – Narrative
(Page 401).
A. Narrative therapists avoid imposing standards of what is normal or abnormal. It is believed that these standards are oppressive to marginalized populations. Narrative therapists avoid placing labels or diagnoses on people as it is believed this encourages the therapist to view individuals as objects.
B. Nichols and Schwartz (2001, p. 395) state that narrative therapists believe “people: have good intentions — they don’t want or need problems, are profoundly influenced by the discourses around them, are not their problems, and can develop alternative, empowering stories once separated from their problems and from the cultural common wisdom they have internalized.”
(Page 401).
130
Development of Behavioral Disorders
Narrative
(Page 401).
A. The manner in which people see themselves is shaped by the dominant discourses of the culture.
B. These stories are typically problem-saturated and influence the thinking and behavior of the individual as long as he/she remains unchallenged.
(Page 401).
131
INTEGRATIVE MODELS
Key figures
(Page 404).
William Pinsof; Joseph Eron; Thomas Lund; Richard Schwartz; Neil Jacobson; Andrew Christensen
(Page 404).
132
Overview – Integrative Models
(Page 404).
A. Integrative family therapy refers to a formal decision-making process by which techniques are borrowed from a variety of models. There is no single integrative model, rather there are numerous efforts to construct new models.
B. The term “integration” refers to three approaches:
1. Eclecticism draws from a variety of approaches.
2. Selective borrowing in which techniques or concepts are taken from models to compliment one primary model.
3. Specially designed integrative models are theoretical models that draw on several approaches.
(Page 404).
133
Goals of Treatment – Integrative Models
(Page 404).
A. When therapists combine aspects from a number of models, they achieve increased comprehensiveness. The previously outlined models typically have a narrow focus on a certain area. Integrative models usually draw understanding into a wider range of phenomena thus increasing the requisite variety of the therapist.
B. Another goal is to expand the horizons of understanding without losing focus. Rather than create an entirely new model, theorists can utilize the previously organized concepts and enhance their usefulness.
(Page 404).
134
Key Concepts and Terminology
| Integrative Model
A. Cross model boundaries
B. Combine theoretical or technique elements from various models
C. Focused on client and presenting problem
D. Identify generic elements of treatment
E. Reflect a broad view of the change process
F. Appreciate diversity of thought in the field
G. Pragmatic in nature
H. Focus on one or more systems’ elements (individual, couple, family)
I. Emphasize the self-of-the-therapist
(Page 405).
135
COMMUNICATIONS MODEL
Key figures
(Page 406).
A. Major Figures: Don Jackson; Jay Haley B. Secondary Figures: Paul Watzlawick; John Weakland
(Page 406).
136
Overview – Communications Model
(Page 406).
Communication theorists are concerned with three aspects of communication as they relate to the family: A. Syntax – the style or manner in which information is transmitted and received
B. Semantics – the clarity of communication transmission and reception
C. Pragmatics – the behavioral effects of communication
(Page 406).
137
Goals of Treatment – Communications Model
(Page 406).
A. The goals of treatment are individuation of members and improved relationships.
B. An individual focus is assumed with the belief that as individuals grow they will develop greater family cohesion.
C. Improved communication is the primary method used to promote healthy relationships by altering poorly functioning patterns of interaction.
D. Theorists believe that these alterations will block symptomatic behavior, thus leading to its replacement by functional behavior.
(Page 406).
138
Role of the Counselor – Communications Model
(Page 406).
A. The therapist has a directive approach and remains in control of the session.
B. The therapist’s behavior ranges from warm and collegial to more hierarchical and distant.
(Page 406).
139
Role of the Symptom – Communications Model
(Page 406).
The role of the symptom according to communications therapists is to maintain the homeostatic equilibrium of family systems.
(Page 406).
140
Normal Family Development
Communications model
(Page 407).
A. Communication family therapy focuses on the present rather than the past. It has little interest in development. It is interested, however, in negative and positive feedback loops and their influence on the patterns of interaction.
B. Negative feedback loops refer to the relationship balance achieved despite environmental influences. When the family begins to be unstable, a regulatory system “kicks in” to bring it back to a comfortable level of homeostasis.
C. Positive feedback alters the system to accommodate to changing circumstances. Flexible families are able to maintain stability but also modify their rules when the need arises.
(Page 407).
141
Development of Behavioral Disorders
(Page 407).
A. Symptomatic behavior occurs due to the rigidity of the system and its rules.
B. Families become trapped in rigid homeostatic patterns of communication and are unable to adjust to change.
C. Change is viewed as threatening, and the system resists it.
D. As a family member attempts to change, the family attempts to restore homeostasis by labeling him/her as sick.
(Page 407).
