Family Therapy

A systemic approach

The family as a system

Systems are composed of units who have some relationship to each other and are organized around those relationships

Solar system Educational system

A change in one part causes a change in another

The etiology of problems

Family characteristics: Problems (even an individual’s psychological symptoms) are assumed to be caused by a dysfunctional family characteristic family structure (adaptability and cohesion) the nature of family interactions

Family Homeostasis: When disruption occurs, family members try to regain a stable environment by using strategies that decrease stress and restore balance. These strategies are not always adaptive in long-run.

Family characteristics: Boundaries

Boundaries are implicit family rules that determine how family members relate to each other, including who talks to (or spends time with) whom, how decisions are made and by whom, and how much family members know about each other’s lives.

Family characteristics: Boundaries/Cohesion

Enmeshment People are enmeshed (or fused) when they are unable to

think or act independently.

People who are not enmeshed are autonomous and have emotional separation from their family.

A person’s level of differentiation is often related to his or her parents’ level of differentiation. It’s often transgenerational.

People with low levels of differentiation are more reactive to environmental stressors. When under stress they are more likely to try to resolve it by:

Withdrawal Destructive conflict Dysfunction Triangulation

Disengagement

Family Adaptability

Adaptability refers to the family’s rules about who does what and it’s ability to adapt as necessary

When there are few rules (or rules are not enforced), family functioning is chaotic

When the rules are too rigid, families have trouble adapting to change

Family Circumplex Model

Family Life Cycle Stages

Single young adult leaves home

Forms a family through marriage

Has young children

Children reach adolescence

Children move out

Retires

Family life cycles and family functioning

Family dysfunction often is a result of unmet family developmental tasks.

Family life cycle changes are a major source of stress and disequilibrium for families.

As families grow, there are developmental tasks that are required; when a family negotiates these tasks successfully, family roles and structures change.

When the family does not or can not accommodate these changes, stress and symptomatology will occur.

It is not the normal difficulties that create the problem but rather the chronic mishandling of problems over time.

The nature of change

Change/healing occurs when family members

1) Gain insight about their dynamics

2) Change repetitive patterns that hinder the family

Learn more effective ways of communicating

Change family roles

Develop more healthy boundaries

The Initial Interview

Pre-session Planning: The therapist determines in advance who will attend the session.

The Joining Stage: The therapist joins with the family, taking on their affective tone, tempo, language and structure.

The Problem Statement Stage: Who gets to initially frame the “problem”? Sometimes the person who has the least involvement with the problem is addressed first.

Initial Interview (continued)

The Interaction Stage: The therapist focuses in on determining the patterns of interaction sustaining the problem.

In-Session Conference: The therapist leaves the family for a few minutes and confers with observers or takes a moment alone to think about what has been said and how that relates to the therapist's hypothesis regarding the problem.

Goal Setting Stage: The therapist reaches an agreement with the family on a solvable problem, stated in a behavioral term so that all involved will know when the problem has been solved.

Ending Stage: The therapist sets the next appointment and indicates which family members will be present.

Post-session: Debriefing and processing

Family Therapy Assessment Techniques

Family Interview

Circular Questioning: The same question is asked of each family member.

Family Sculpting: Assessment tool that examines power and closeness in a family by asking each family member to physically arrange all other family members in order of relationships.

Reenactment: Asking the family to act out a situation rather than describe it verbally.

Genogram: Gives a picture of three or more generations (like a family tree) and notes important family dynamics, rules, patterns, mental health issues, etc.

Stan’s Genogram

What the genogram tells us

Mom married Dad (after he stopped drinking and went to AA) but they had contentious life

Mom’s Dad drank (and went to AA)

Mom’s Mom drank (but denied problem)

Matt, Stan’s sisters husband drinks as does Stan (and Stan’s Mom has problem with them both)

Karl the younger brother is close to Stan

Stan is distant or disengaged from Dad & older brother

Family Therapy Intervention Techniques

Reframing: The problem must be put into solvable, behavioral terms, be referenced as a family problem and not just the problem of one family member, and be put into positive terms.

Giving Directives: Creating or selecting an intervention that will impact the presenting problem.

Modifying the structure

Switching roles

Family Therapy Techniques (cont.)

Rituals: Symbolic acts that help the family move. (e.g. burying a box that contains family anger.)

Ordeals: An ordeal is a behavior that is more obnoxious, frustrating, and time consuming than the behavior that is considered the symptom. When the symptom behavior occurs, the family is instructed to perform the ordeal.

Ambiguous Assignments: Helps break down linear thinking and causes the family to be more creative in problem solving.

Major Family Therapies

1950’s: Several psychologists break away from psychodynamics and argue that dysfunctional behavior is rooted in the individual’s past and present family life.

Jay Haley (and others) develop strategic family therapy.

Virginia Satir develops conjoint family therapy

Salvador Minuchin develops structural family therapy.

Murray Bowens develops transgenerational family therapy.

Carl Whitakers develops experiential family therapy.