Family Systems TherapyC6436 Individual Counseling Theory and Practice James J. Messina, Ph.D.

Family Therapists Leaders

Alfred Adler-Rudolf Driekurs-open forum Child Guidance Clinics Murray Bowen-Multigenerational Model-Triangulation, Differentiation of Self Virginia Satir-Conjoint Family Therapy-Human Validation, Relational Family Therapy Carl Whitaker-Experiential Symbolic Family Therapytherapist coach influences change Salvador Minuchin-Structural Family Therapy-create structural change Jay Haley-Strategic Family Therapy-solves problems now Cloe Madanes- Wife Haley-Strategic Family Therapy

The Family Systems Perspective

Individuals ~ are best understood through assessing the interactions within an entire family Symptoms ~ are viewed as an expression of a dysfunction within a family Problematic behaviors ~

Serve a purpose for the family Are a function of the familys inability to operate productively Are symptomatic patterns handed down across generations

)

A family ~ is an interactional unit and a change in one member effects all members

Difference between Systemic & Individual Therapy modelsIndividual Therapist Obtain accurate diagnosis DSM IV Begin Therapy right now Focus: causes, purposes, processes Concern with individual experience & perspective Intervene to help individual learn to cope Systemic Therapist Explore System for family process & rules Invite in parents, siblings Focus: family relationships Concern transgenerational meanings, rules Intervene to change context within family system

Beliefs of Family Therapists

Individuals affiliations & interactions have more power in persons life than a single therapist could ever hope to have Working with family or community therapists sees how individual acts and serves needs of these systems Seeing individual in active in a systems assists in developing types of interventions needed

Systemic Perspective

Individual may carry a symptom for the entire family Individuals functioning is a manifestation of way family functions Individual can have symptom existing independent of family structure Symptoms always have ramifications for family members Change the systems and individuals will change Change dysfunctional patterns of relating & create functional ways of interacting & relating

Adlerian Family Therapy Outline1. 2. 3.

Key Concepts Therapy Goals Therapists functions

Adlerian Family Therapy Key Concepts

Adlerians use an educational model to counsel families Emphasis is on family atmosphere and family constellation Therapists function as collaborators who seek to join the family Parent interviews yield hunches about the purposes underlying childrens misbehavior

Family Atmosphere

Unique: conjunction of all the family forcesclimate of relationships that exist between people Family is a system & each member exerts influence on every other member Autocratic or permissive common in West Parent role model of how genders relate, how to work, participate in world Emotional role models for children as well Family value: value all members support & cannot be ignored: religion, education, money achievement, right and wrong

Family Constellation

Consists of parents, children, extended family members Birth order How member find place in family system & how relate to one another to be unique Alignment of family members Develop genogram of family-starting point for client communication meaning of life

Role of Birth OrderMotivates later behavior:

First-born: favored, only, pseudo-parenthigh achievers

Second-born: rivalry & competition Last-born: more pampered,

baby-creative, rebellious, revolutionary, avant-garde

Birth OrderAdlers five psychological positions: Oldest child ~ receives more attention, spoiled, center of attention Second of only two ~ behaves as if in a race, often opposite to first child Middle ~ often feels squeezed out Youngest ~ the baby Only ~ does not learn to share or cooperate with other children, learns to deal with adults

Mistaken Goals: Interactional View

Four goals for childrens behaviors:

Attention getting Power struggle Revenge Demonstration of inadequacy

Short hand explanations, descriptions of consistent patterns

Describe childs misbehavior Parents reaction to behavior Childs reaction to parents attempt to discipline

Mistaken Goal: recognition flex smile, twinkle Goal recognition and disclosure

Adlerian Family Therapy Goals

Unlock mistaken goals and interactional patterns Engage parents in a learning experience and a collaborative assessment Emphasis is on the familys motivational patterns Main aim is to initiate a reorientation of the family Assist family member to have Social Equalitythe sense that everyone has an equal right to be valued and respected in the family

Adlerian Therapist Functioning

Open forum

Parent Interview alone they are leaders Problem Description parents concerns Goal Identification What did you do about it? Typical Day repeated patterns of interaction Goal Disclosure Do you know why you do Posit tentative goals: Could it be that

Child Interview

Concluding Remarks to generate new approaches to end mistaken interactions to lead to more democratic, harmonious, effective living

Multigenerational Family Therapy Outline-Murray Bowen1. 2. 3.

Key Concepts Therapy Goals Therapists functions

Multigenerational Family Therapy Murray Bowen 8 Key Concepts

2. 3. 4. 5. 6. 7. 8. 9.

The application of rational thinking to emotionally saturated systems. A wellarticulated theory is considered to be essential Differentiation of the self Triangulation Nuclear Family Emotional System Family Projection Process Emotional cutoff Multigenerational transmission process Sibling position Societal regression

Differentiation of the self

A psychological separation of intellect & emotion & independence of self from others Differentiated =Being able to be guided by thoughts or emotions separateness Undifferentiated=difficulty separating self from others-fuse with dominant family emotional patterns-physical but not emotional leaving Unproductive family dynamics of previous generation transmitted by marriage of undifferentiated individuals Need for self-identify while still belonging to ones family

Triangulation

A third party is recruited to reduce anxiety and stabilize a couples relationship Underlying conflict not addressed & worsens Once the 3rd person is resolved the balance achieved is off again Change in one part of family system affects the whole system Therapist must be highly differentiated so as not to get caught up in triangulation with couple

Multigenerational Family Therapy Goals

With the proper knowledge the individual can change

Change occurs only with other family members

To change the individuals within the context of the system To end generation-to-generation transmission of problems by resolving emotional attachments To lessen anxiety and relieve symptoms To increase the individual members level of differentiation

Multigenerational Family Therapy Therapist Functioning

Genogram work: look at family over three generations

Look for critical turning points in family emotional process Characteristics of family members Evolutional picture of family: tools for assessment

Asking Questions: What role did you play with that person in the family? Looking for fusion within the family.

Conjoint Family Therapy Outline1. 2. 3.

Key Concepts Therapy Goals Therapists functions

Conjoint Family Therapy Key Concepts-Virginia Satir

Enhancement and validation of selfesteem-Human Validation Process Model Family rules Congruence and openness in communications Sculpting Nurturing triads Family mapping and chronologies

Conjoint Family Therapy Goals

Open communications

Individuals are allowed to honestly report their perceptions Family decisions are based on individual needs Differences are acknowledged and seen as opportunities for growth

Enhancement of self-esteem

Encouragement of growth

Transform extreme rules into useful and functional rules

Families have many spoken and unspoken rules

Family Life

Children enter pre-existing systems which have rules Rules about living & interaction Rules governing Communications-who says what under what conditions Rules spoken and unspoken: shoulds and should nots Rules become absolutes & often are impossible: Never be angry with your father. Always keep a smile on your face As child accept rules for survival which are not useful as adult

Functional vs. Dysfunctional Communications

Functional: each family member give chance to be individual, separate life lots of freedom and flexibility in family with open communications Dysfunctional: closed communications, poor self-esteem of parents, rigid patterns-resists awareness, strained relationships, little individuality, incapable of autonomy or genuine intimacy: Family members: think, feel and act the same way: family controlled by fear, punishment, guilt or dominance

Defensive Stances in Coping with Stress1.

2. 3. 4.

Placating-enabler, people pleaser, rescuer Blaming-troubled person Super-responsible-looking good Irrelevant behavior-distracting- acting out, entertainer

Family Roles and Family Triads

Roles played in family based on ones behavior

Victim Keeping the Peace Stern Taskmaster Disciplinarian Hard-working caregiver

Nurturing Triad two parents and child where child is nurtured

Conjoint Family Therapy Goals

Communicating Clearly Expanding awareness Enhancing potentials for growth in self-esteem Coping with demands & process of change Identify new possibilities to the status quo Encouraging growth in each member Generating hope, courage to formulate new options Assess, strengthen, enhance coping skills Encourage members to exercise healthy options

Therapist Functions

Focus on emotional honesty, congruence, systemic understanding Family sculpting: position family members by roles they play in family Family reconstruction: psychodramtic reenactment significant event in 3 generations of family-unlock dysfunctional patterns stem from family of origin

Experiential Family Therapy Outline-Carl Whitaker1. 2. 3. 4.

Key Concepts Therapy Goals Therapists functions Techniques

Experiential Family Therapy Carl Whitaker

A freewheeling, intuitive, sometimes outrageous approach aiming to:

Unmask pretense, create new meaning, and liberate family members to be themselves

Techniques are secondary to the therapeutic relationship Pragmatic and atheoretical Interventions create turmoil and intensify what is going on here and now in the family

Experiential Family Therapy Key Concepts

Subjective Focus: subjective needs of the family members Assumption all family members have a right to be themselves Needs of family may be suppressing rights of the individual Goal for authenticity, no right or wrong way to be

Atheoretical Stance

Pragmatic stance Theory can be hindrance to clinical work Often times theory is way for therapist to create distance from clients and control anxiety of the therapist to hide behind Intensify present experiencing of family members to reach unconscious to understand what is really going on in the family Process to help tap into: Family secrets just keeping the secrets keeps the family crazy

Experiential Family Therapy Goals

Facilitate individual autonomy and a sense of belonging in the family Help individuals achieve more intimacy by increasing their awareness and their experiencing Encourage members to be themselves by freely expressing what they are thinking and feeling Support spontaneity, creativity, the ability to play, and the willingness to be crazy

Therapist Function in Experiential Family Therapy

Create family turmoil Coach family how to get out of the turmoil Highly involved therapist model: must be transparent, take risks, get involved with family in the sessions Help family member experience the here and now by therapist BEING WITH the family Three phases: engagement (all powerful), involvement (dominant parent figure, adviser) & disentanglement (more personal, less involved)

Structural Family Therapy Outline - Salvador Minuchin1. 2. 3.

Key Concepts Therapy Goals Therapists functions

Structural Family Therapy Salvador Minuchin

Focus is on family interactions to understand the structure, or organization of the family Symptoms are a by-product of structural failings Structural changes must occur in a family before an individuals symptoms can be reduced Techniques are active, directive, and well thought-out Focus on the how, when, and to whom family members relate

Key Concepts Structural Family Therapy of Salvador Minuchin

Family Structure: invisible set of functional demands or rules that organize way family members relate to one anotherObserve family to see the structure:

who says what to whom, in what way, with what result

Family Subsystems

Spousal: wife & husband Parental: mother & father Sibling: children Extended: grandparents, other relatives Family member play a different role in each of the subsystems they belong Structural difficulty when one subsystem takes over or intrude another

Boundaries

Emotional barriers that protect & enhance the integrity of individuals, subsytems & families Extremes of boundaries Disengagement-overly detached-rigid Enmeshment-very involved as one-diffusefosters dependency on parents Clear healthy boundaries-attain sense of personal identity yet allow sense of belongingness within family system

Structural Family Therapy Goals

Reduce symptoms of dysfunction Bring about structural change by:

Modifying the familys transactional rules Developing more appropriate boundaries Creation of an effective hierarchical structure It is assumed that faulty family structures have: Boundaries

that are rigid or diffuse Subsystems that have inappropriate tasks and functions

Structural Family Therapist Function

To actively engage family as unit to initiate structural change by:1. 2. 3.

Joining the family in a position of leadership Mapping its underlying structure Intervening in ways designed to transform an ineffective structure

The Therapeutic Endeavor is challenging rigid transactional patterns1. 2. 3.

Pushing for clearer boundaries Increasing degree of flexibility in family interactions Modifying dysfunctional family structures

Structural Family Techniques

Joining: build & maintain therapeutic alliance with family Family Mapping: draw map to identify boundaries , transactional styles Enactments: family engages in conflict situation that would happen at home Reframing: new light or different interpretation on problem situation in family

Strategic Family Therapy Outline1. 2. 3.

Key Concepts Therapy Goals Therapists functions

Strategic Family Therapy Key Concepts

Focuses on solving problems in the present Presenting problems are accepted as real and not a symptom of system dysfunction Therapy is brief, process-focused, and solutionoriented The therapist designs strategies for change Change results when the family follows the therapists directions and change transactions

Strategic Family Therapy Goals

Resolve presenting problems by focusing on behavioral sequences Get people to behave differently Shift the family organization so that the presenting problem is no longer functional Move the family toward the appropriate stage of family development

Problems often arise during the transition from one developmental stage to the next

Strategic Family Therapists Function

Therapist: consultant, expert, stage directorchange is therapists responsibility Use of Directives: designed to change the system: advice, suggestions, coaching, giving ordeal-therapy assignment Paradoxical Interventions: exaggerate or perfect a problematic behavior Reframing: reinterpreting problematic behaviors which are entrenched-giving new meaning to behaviors may produce new behaviors that fit the new interpretation

Social Constructionism

The client, not the therapist, is the expert Dialogue is used to elicit perspective, resources, and unique client experiences Questions empower family members to speak, and to express their diverse positions The therapist supplies optimism and the process

Social Constructionism Therapy Goals

Generate new meaning in the lives of family members Co-develop, with families, solutions that are unique to the situation Enhance awareness of the impact of various aspects of the dominant culture on the family Help families develop alternative ways of being, acting, knowing, and living