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171 Cards in this Set
- Front
- Back
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History of Family Therapy- 40's
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Begun by research therapists from different disciplines
-Shift occurring with cybernetics model, emphasis on organization, pattern, and process. -Gregory Bateson |
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History of Family Therapy- 50's
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-Emphasis on community, cooperation, and creation
-Ackerman, Whitaker, Wynne, Bell, Bowen, Lidz, Boszormenyi-Nagy, Midelfort |
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History of Family Therapy- 60's
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-Shift: expanding knowledge of therapy, enlarging repertoire of techniques
-expansion of Family Therapy -Jackson, Satir, Haley, Weakland, Riskin, Fisch, Watzlawick, Minuchin |
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History of Family Therapy- 70's
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-Development into schools and models
-clear definitions -Milan, Palazzoli, Cecchin, Boscol, Prata |
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History of Family Therapy- 80's
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-Integration
-Awareness of outside systemic frame of reference had impacted family therapy |
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History of Family Therapy- 90's
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-Challenge and innovation, self critique and more integration
-somewhat complacent -lack of attention to gender related issues |
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Systems Paradigm
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Walsh gives common tenets of systemic model of family therapy:
-Nonsummativity -Boundaries -Circular causality (replacement for linear cause and effect) -A change in part of the system effects the whole system -Self regulating system (seeking homeostasis and equilibrium) -Feedback mechanisms attempt to bring family back into equilibrium -methods bringing equilibrium can become problems -quantity and direction of energy impacts system functioning (entropy and negentropy[change/reorganization]) -relationships w/in the system -Equifinality |
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Nonsummativity
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The whole greater than sum of its parts, and components understood w/i context of whole system
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Feedback
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when a portion of a system's output returns to or is fed back into the system
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Equifinality
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multiple causes for a behavior/event, and multiple effects
-fundamental concept for systems perspective |
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Couples
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-excluding anyone except that couple so as to
-address direct marital relationship issues -clearly mark boundaries for parenting system -respect privacy |
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Characteristics of a healthy couple: Attitudes/Beliefs
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-Multiple realities, all perceptions equally valid
-Perceptions are fallible -differences promote growth -People are neutral, and your partner is usually decent in motive -Human encounters are rewarding -Systematic perspective |
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Characteristics of a healthy couple: Behavior patterns
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-Overt power diff is minimal
-Clear boundaries -Operation primarily in the present -Respect for individual choice -Skill in negotiating is apparent -Positive feelings are shared |
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Characteristics of a healthy family
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-Legitimate source of authority (constant over time)
-Stable rule system -Stable sharing of nurturing -Effective/stable childrearing and marriage-maintenance practices -Goals for the family and individuals -Sufficient flexibility and adaptability to allow normal changes AND unexpected crises |
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Life Cycle Stages- Family
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Listed by Goldenberg &Goldenberg
-Early: Forming and nesting -coupling, task to sift to interdependence -becoming three, task to incorporate dependance Middle stages: Family separation process -Entrances, task to move from dependence to partial independence -Expansion, support continuing separations -Exits, complete independence of one member Last Stage: Finishing -Becoming smaller/extended, continuing expansion of independence -Endings, facilitation of family mourning, final separations |
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Gender issues
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-Recently it has been recognized that there are a lot of gender influences on the family, and these should be looked at and examined
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Psychodynamic Family Therapy
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David and Jill Scharff
-Integrates psychoanalytic, object-relations, and family therapy -uses listening, responding to unconscious, interpreting, insight, and transference for understanding growth -family as a system (not sets of relationships) |
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Psychodynamic Family Therapy Goals
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-Understanding the development of individual personality in the early parent-child relationships
-expand family capacity to perform the holding functions for members and their capacities to offer holding to eachother -Aid family in expressing true understanding and compassion |
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Psychodynamic Family Therapy Counselor role
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Therapist provides nurturing safe environment,
-understanding and resolving object relations, and its interference with relationships |
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Psychodynamic-role of symptom
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Aids therapist in identifying the ego identity and factors for its evolution
-shifting focus from symptoms to relationship to the objects |
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Key issues in normal fam development
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-Internalization/externalization of relationships
-attachment and separation -introjection and projection -transmuting internalization -Disorders develop when children attribute the qualities of one person to another person resulting in distorted perceptions |
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Object relations theory
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Studying individuals and their basic motives, and social relationships
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Splitting
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Children separating their internal world into good and bad aspects
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4 phases of object relations
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-Differentiation: child develops to point where they can explore aspects of mother and others
-Practicing: exploring the world -Rapprochement: children increase awareness of vulnerability and separateness, returning to mother for safety -Object relations consistency: when child realizes their separation but still relatedness to parents |
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Transference / countertransference
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-elements of individuals earlier experience suggests that a person is being related to based on an amended version of the other person involved
-reciprocal interaction (based on above) |
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Internal objects
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Mental images of self and others built from experience/expectations
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Internalization
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-Introjection
-Identification -Ego identity |
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Holding environment
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emphasizes need for closeness and separateness to gain object relations
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Psychodynamic Family Therapy Techniques
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-Recognition and Reworking of defensive labels
-Provide contextual holding so attachment needs are met-growth occurs -Reinstatement of construction of holding relationships to support attachment needs, growth, and individualism -Return of family to overall developmental level needed -Clarification of individual needs |
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Satir's Experiential Family Therapy
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-Virginia Satir
-Belief that humans have innate growth tendency in terms of body, mind, and feelings -Systems viewed holistically and continually interacting -Basic components: rules-influence roles and functioning. Awareness of present experience allows for growth -Focus on self-esteem and addressing interpersonal communication |
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Satir's Goals of treatment
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Facilitation of growth in family and members (self esteem and communication)
Other: -Hope and encouragement -Coping skills -Facilitation of growth oriented movement, by directing energy previously used by symptomatic behaviors |
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Satir's Counselor role
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-Create comfortable safe environment
-Reframe negative emotions -encourage expression of feelings -Education on self-control and accountability -Address noncongruent communication (content and process messages) -Model congruent communication |
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Normal family
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-Clear communication
-Effective Roles -Implemented roles are few, reasonable, relevant, flexible, applied |
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Behav Disorders for Satir
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Closed system family, poor interchange of info
-one member with dysfunction -coping is viewed -rules are fixed, arbitrary, and inconsistent |
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Key concepts of Satir
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-Self-esteem: value one places on self (individual, family)
-Communication: Congruent, or Noncongruent -Roles: Blamer, Placater, Super reasonable, Irrelevant, Congruent -Rules: Rigid or flexible -Human Mandala: self is the core, growth through 8 aspects of mandala |
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8 aspects of mandala
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Physical body
Intellect Emotions The five senses Social needs Nutritional needs Life space needs Spiritual needs |
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Satir's Techniques
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-Family sculpting (pscychodrama)
-Family life fact chronology (patterns) -Family reconstruction (reenactment of certain aspects of family history) -Reframing (problem interpretation) -Verbalizing presuppositions (making family presumptions overt) -Denominalization (giving behav. descriptions for feelings) -Anchoring (relating physical stimulus with previous experiance) -Multiple family therapy (several families) |
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Whitaker's experiential family system
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-Carl Whitaker
-Kempler, Keith, Napier, Duhl -Emphasis on immediacy -quality of ongoing experience -emotional expression important |
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Goals of Whitaker's Experimental
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To help growth and enable to do that within a family
-Helping family members to experience themselves in the system and as individuals |
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Whitaker's Experimental Counselors role
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-Caring, entering system, expert, directive offered
-Neutral stance taken -increasing the level of anxiety gradually -Uses paradox to escalate pressure, psychotoc-like episode, to help client reintegrate |
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Normal families- Whitaker's Experimental
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-self-actualizing
-growth even in problems -autonomy, flexibility -family coming together and apart as wanted -open stories, available to other systems -no primary symptom bearer |
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Disorders Whitaker's Experimental
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-enmeshment or disengagement
-denying feelings -self-protective, avoiding risk taking -battle for control -belief that confrontation/conflict will destroy a family |
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Whitaker's Three phases of therapy
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Engagement: joining
Involvement: longest, most change, commitment to therapy is increased, investing in ones own change -Disentanglement: gradual separation, client empowered, need for continued growth encouraged |
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Whitaker's- Redefining symptoms
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helps growth
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Whitaker's Modeling
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fantasy alternatives to real-life stress
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Whitaker's Separating
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separation of interpersonal stress and intrapersonal stress
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Structural Family Therapy
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Salvador Minuchin
-Aponte, Fishman, Roseman, Colapinto, Montalvo -Families come to therapy because they feel stuck -Helping families become unfrozen from rigid patterns and open opportunities for new structures |
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Goals of Structural Family Therapy
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-Changing the underlying structure of a family- thus addressing problems
-Secondary goal is to determine goals for specific problem by diagnosis of structure and therapy stage |
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Counselor Role Structural Family Therapy
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-Active participant in system
-Role of the expert, active, directive -Encouraged to use flexible approach, integrating personal style |
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Symptom- Structural Family Therapy
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-One member is symptom bearer, to relieve pressure from dysfunctional family
-Family focus on symptom person instead of dysfunction |
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Disorders- Structural
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-inflexible family structure
-inability to restructure to meet challenges -4 forms of pathology |
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4 forms of pathology - structural
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1)Pathology of boundaries: too rigid/diffuse
2)Pathology of alliances: relationships not good for family functioning, conflict or cross-generational coalitions 3)Pathology of triad: to members alliance against a third 4)Pathology of hierarchy: child is parentified and parent is excluded |
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Family structure- Structural
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Invisible, covert set of demands and codes organizing the family interactions
-internal organization dictating how when and who to relate to |
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Family Subsystems
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Components of family structure
-carry out necessary tasks -rules of membership and boundaries -long term or temporary -most common: spousal, parental, sibling |
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Boundaries
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Rigid: impermeable barriers between systems, disengagement
Diffuse: excessively blurred and indistinct. General hierarchy but enmeshed, difficulty with relationships outside the family. Clearly defined: maintaining separateness and connectedness |
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Alignments (alliances)
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Emotional/psychological connections based on members joining or opposing one another
-A triangle: a dysfunctional alignment, two alignments against another individual |
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Coalitions
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-triangle
-Stable: fixed, inflexible, part of normal family life -Detouring: conflictual, holding third person responsible for difficulties to decrease self stress. |
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For parental success
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There must be:
-general boundaries -alignments between parents on key issues -Rules related to power/authority |
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Joining and Accommodating techniques - Structural
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Establish effective working relationship
-Accomodation: therapist modifying language/tone/style -Maintenance:focus on highlighting certain behaviors -Tracking: clarification/amplification of communication -Mimesis: adoption of client's communication style |
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Restructuring techniques
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Techniques impacting family structure
-Structural map: symbolic of family structure -Enactment: performing interaction -Escalation of stress -Boundary making -Utilizing the symptom -Mood manipulation: -Support, education, and guidance |
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Strategic Family Therapy
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-Jay Haley
-Cloe Madanes -views families as rule-governed systems -symptoms maintain system and are maintained by system -destructive cycles prevent family from achieving purpose |
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Goal of Strategic
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-Address presenting problem
-relational dynamics connected to system addressed -avoidance of insight on relational process though |
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Role of counselor- Strategic
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-Neutral, directive, in control
-expert -maintaining focus on problem -providing support and challenging |
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Symptom- Strategic
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-Maintain the system
-used to control the relationship if other strategies have failed -Inevitability of vying for control -pathological only if one partner deny's attempts to control |
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Disorders
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-Hierarchical structure is unclear or inappropriate
-problems addressed at the wrong level of hierarchy -Denial of problems, or creating problems where none existed |
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Hierarchy
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Decision-making structure of a family. Age, gender, roles, or education
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Aliances/coalitions
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formed by joining 2+ members against another. Sometimes child then in parent role
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Communication
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Digital: content focused
Analogic: body language and symbolism |
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Symptoms
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Patterns of interaction that are problematic. Root concern of family.
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Techniques
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Directives: Straightforward or Paradoxical
Empowerment (busting morale) Structured Interview (interview assessment/diagnosis) |
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Straightforward Directives
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Advise, explaniations, or suggestions
changing interaction sequence in family -Metaphorical tasks: not directly related to problem -Devil's pact: agreement to do a hard task without knowing what it is yet. |
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Paradoxical Directives
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Tasks where success is based on family defying the instructions or following them to the extreme then withdrawing
-Reframe -Prescribing the symptom -Restraining the changes (too fast=relapse) -Pretend technique (acting the problem and helping) -Ordeals |
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Bowen Model
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Murray Bowen
-Fogarty, Friedman, Guerin, Kerr -The key dysfunction is exaggerated togetherness -helps with differentiation of self |
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Goals of Bowen Model
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-Decreased anxiety
-Increased differentiation of self -Attention to process (patterns of emotional reactivity) and structure (patterns of interlocking triangles) |
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Counselor Role -Bowen Model
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-Coach, researcher, active expert
-third side of a therapeutic triangle -works with parental dyad |
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Symptom- Bowen Model
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-the most vulnerable person in the triangle
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Behavioral Disorders- Bowen Model
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Low differentiation = stress and provoking symptoms
-stabilizing stress filled system -third party being neutral -no emotional involvement -the most vulnerable person usually develops symptoms |
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Differentiation of self
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-distinction between rational thought and emotionality
-balance between separateness and togetherness -balance |
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Triangle
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building block of familys emotional stability
Third person drawn in when emotions are high to stabilize. The stress of that causes symptoms. More people needed to carry the stress as it grows |
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Nuclear family emotional system
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-How anxiety is projected from individual to family
-low differentiation = higher emotional fusion -results in conflict, emotional distance, etc. |
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Family projection process
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Parents transmitting dysfunction to children
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Societal regression
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when emotional process of society impacts process of family. Society becomes more anxiety ridden, and family has lower differentiation
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Techniques
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Genograms
Process questions (about interaction patterns) -Therapeutic triangle (includes therapist to stabilize without emotion) |
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Milan Systemic Family Therapy
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-Mara Selvini-Palazzoli, Luigi Boscolo, Gianfranco Cechin, Guiliana Prate
-Systemic, viewing patterns of interaction handed down from generation to another -change is is important -time between sessions -Change of behavior and cognition |
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Goals of treatment- Milan
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-Rules of the family game
-Making rules overt -Creating their own solution -Understanding the role of the symptom |
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Role of counselor- Milan
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Participant in the system
-family impacts therapist, therapist impacts family -3 aspects: neutrality, change promotion (through rule changes), and making rules of the game overt -Maintains control, but not giving perspective -nonconfruntational, team approach |
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Role of the synptom
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-Member manifests symptom to protect other members
-serves a function in the system, which organizes around it -Key to determining the rules of the family game |
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Disorders- Milan
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The family game demonstrates the dysfunction
-This game involves even extended family members, and long time periods sometimes -power alliances, across generations |
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Circularity
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-Recursive nature of living systems
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Significant system
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system organized around the presenting problem (parents, school, friends, etc)
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Treatment process- Milan
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-Telephone interview
-pre-session meeting -session 1 -2 -3 -4 |
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Session 1
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interview of family/friends, therapist and team gather, team takes a break to organize and revise hypothesis and prepare prescription, given to family with a positive connotation
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Session 2
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-Just nuclear family
-changes in family recognized, -assessment for issues specific to nuclear family -connecting, analysis, and testing |
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Session 3
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parents alone
-Assessment continued, team gives parents prescription for change |
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Session 4
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Final session
reviewing parental observations, addressing responses about additional prescriptions |
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Prescriptions
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A paradoxical injunction where therapist directs family members to perform symptomatic behavior
-if followed family has symptom under control -if not followed symptom is given up |
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Circular questioning
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-question designed to help people seem selves in a relational way
-Structured so that a person must give a relational description as answer |
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Hypothesizing
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-central to model
-speculations about the role of the symptom and manner in which family organized around it -before initial session, and throughout -In order to not buy into the family's problem definition the team needs a hypothesis ahead of time |
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Family CBT
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Albert Ellis and Aaron Beck
-Baucom, Datillio, Epstein -classical and operant conditioning -behavior is manipulated by its consequences |
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Goals of treatment- CBFT
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-Elimination of undesirable behaviors and increasing positive behaviors
-Family determines the desire to change -Therapist empowers family to solve own problems through education -Teaching about irrational beliefs and changing distortions |
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Role of counselor- CBFT
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-Directive, expert on behavior/cognition
-assisting with cognitive distortions and education of better ways to handle thought process |
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Symptoms
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Learned responses, involuntarily acquired and reinforced
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CBT- Disorders
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develop and are reinforced by family members.
-at the root are illogical beliefs and distortions |
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Key Concepts
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-Behavioral
Operant responses Respondent responses Reinforcements Extinction Theory of Social change -Cognitive behavioral Family relationships/cognition's/emotions/behavior influence each other Family schemas |
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Operant Responses (causes)
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not automatically created by stimuli
Occurrence affected by consequences |
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Respondent responses (effects)
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under control of stimuli
not affect the frequency of occurance |
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Reinforcements
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accelerate behavior- negative reinforcers,positive reinforcers
decelerate behavior- implementing negative reinforcer (spank), withdrawl of positive reinforcer |
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The Theory of Social Change
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People maximize profits and minimize costs
-in a functional relationship, people maximize a rewarding relationship -Dysfunctional relationship, people focus on self-protection |
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Family Schemata
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Beliefs of the family members about the family
-formed through years of interactions -2 sets regarding family of origin about families in general |
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Operant CBT- Techniques
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-Shaping-creating new responses
-Contingency contracts -Contingency management -Token economies -Time out |
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Contingency contract and management
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-parents agreeing to make changes if child makes changes
-giving or taking away rewards or punishments based on behavior of child |
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CBT- Techniques - Respondent conditioning
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modification of physiological responses
-desensitization, assertiveness training, aversion, and sex therapy |
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CBT- Techniques - Cognitive effective
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Thought-stopping:awareness of automatic thoughts and replacing these
Rational Emotive: seeing illogical beliefs and distortions to be addressed by individuals |
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Brief Solution Focused Family Therapy
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-Steve deShazer
-Insoo Berg -Lipchik, O'Hanlon, Peller, Weiner-Davis, Walter -focus drawn to exceptions or solutions -problem cause de-emphasized -brief and goal focused |
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Solution Focused Goals
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-helping client change focus
-different perspectives help increase life satisfaction -this perspective is seen when client moves toward desired goal -determine goals |
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Solution Focused- Role of Counselor
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-Partner
-directive in shifting focus, family is still the expert -Emphasizes exceptions and solutions -warm and caring -change is expected |
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Solution Focused- Disorders
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-focus of sessions is on being successful instead of wrong
-solutions to problems separate from their formation -determining cause is unimportant |
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Solution Focused Concepts- Death of resistance
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-Clients desire change and put aside resistance
-therapy is collaborate and flexible |
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Solution Focused Concepts- Client types
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-Visitors: either mandated or someone brought them, no complaint and are welcome but not given assignment
-Complainants: expect a solution to complaint but don't want to change, given observational assignment -Customers: have a complaint and want to change, moving clients here is the goal |
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Solution Focused Concepts- Constructivism
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the belief in multiple realities that are co-created
believing that language shapes reality |
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Solution Focused Techniques- Negotiation Goals
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Emphasis on the belief that clients want change and if they have a clear, attainable goal they will move to it
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Solution Focused Techniques- Exceptions
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Times the problem doesn't take place
Exception oriented thinking is encouraged |
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Solution Focused Techniques- Formula (1st session task)
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homework assignment
client asked to observe exceptions or what in their relationships that they want to continue |
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Solution Focused Techniques- Scaling question
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-Helps clarify ambiguous goals/feelings
-where they are now in comparison to the worst it was, to the best it could be. |
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Solution Focused Techniques- Coping questions
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-Client asked how they have coped so far
-These ways of coping should be noted as strengths |
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Solution Focused Techniques-Normalizing
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-When therapist aids the client in understanding others experience the same things as them
-Helps the client feel normal, not pathological or hopeless |
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Narrative Family Therapy
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-Michael White
-David Epston -Parry and Doan -Social constructionist perspective -uses metaphor of a narrative to help clients understand overcoming a problem-saturated story and creating a new one -language importance is stressed |
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Narrative Therapy - goals
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-Enabling people to write a new story, emphasis on their preferred ways of relating
-Removing the problem from their identity with externalization of problem -Deconstruction of the problem-saturated story and reconstruction of a new narrative. |
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Narrative Therapy - Counselor role
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-Collaborative
-family is an expert regarding their story -Counselor is the editor and publisher -Counselor is expert at helping reauthor the story |
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Narrative Therapy- Disorders
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People seem themselves based on the dominant cultural conversations lead
-These stories are problem-saturated and lead to a person feeling stuck |
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Narrative Therapy Concepts - Storying of experience
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-The organization and meanings given to ones experiences
-as the story is authored is helps understanding and experiance |
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Narrative Therapy Concepts -Alternative Stories
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When person realizes they are separate from their problems they can chose alternative stories
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Narrative Therapy Concepts -Dominant discourses
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The cultural messages that empower or subjugate subgroups
-internalized, these lead to problem saturated stories |
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Narrative Therapy Techniques- Tracking
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-Process of attending the client and their story, joining
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Narrative Therapy Techniques- Deconstruction
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-Dismantling the problem through analysis of its credibility
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Narrative Therapy Techniques- Locating unique outcomes
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emphasis placed on times when the problem was not occurring
3 types -historical -current -future |
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Narrative Therapy Techniques- Restorying/reauthoring
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giving new meaning to experiences one has lived. Rewriting the old story
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Narrative Therapy Techniques- Using the audience/witnessing
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-inviting others to be involved in solidifying the new story
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Communications Model
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-Don Jackson
-Jay Haley -Watzlawck, Weakland -communication as it relates to families: Syntax, semantics, and pragmatics |
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Syntax
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The style/manner that information is transmitted and received
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Semantics
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The clarity of the communication transmission and reception
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Pragmatics
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The behavioral effects of that communication
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Communications Model- Treatment Goals
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-individuation
-improved relationships -as individuals grow cohesion develops -healthy relationships need good communication -family member labled as sick when they try to change, to keep homeostasis |
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Negative feedback loops
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balance in a relationship, despite environment
In instability the system regulates itself |
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Disorders- Communication
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-Rigidity of system and rules
-feeling trapped in the system, without adjustment to change -change viewed as threatening |
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Concepts in Communication- Metacommunication
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communication about communication
-people cannot not communicate -Messages have a report and command function -Command- rules for interactions, stabilize -Family homeostasis -Complementary relationship & symmetrical relationships -communication is punctuated |
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report and command
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-Report is the content of message
-command is focused on the definition of the relationship |
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-Complementary relationship & symmetrical relationships
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-Complementary relationship:based on differences that fit together
-symmetrical relationships: quality, behavior of one mirrors that of the other |
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Concepts in Communication- Circular causality
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focus on the patterns of interaction, not the causality of the symptoms
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Communications- Techniques
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-Teaching clear communication
-Analyzing and interpreting communication patterns -Using strategic interventions to manipulate interactions -Make dysfunctional rules explicit |
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Teaching communication (3)
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uses straightforward directives by the therapist. Most common:
-Peak n first person singular -Make personal statements (I) -Speak directly to, not about, eachother |
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Strategic interventions
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-Reframing
-Therapeutic paradox: assigning the completion of a task that is in direct conflict with expressed desires of client system |
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Boundaries- Nichols
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Emotional barriers protecting and enhancing the integrity of the individual, subsystem, and family
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Boundaries- Minuchin
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Invisible barriers in the family
regulate amount of contact between people |
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Communication theory
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based on relationships through verbal/non-verbal exchanges
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Concurrent therapy
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treatment of two or more related persons by different therapists
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Conjoint Family Therapy
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Satir
-two or more members doing treatment together |
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Cybernetics
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-analysis of flow of information in a closed system
-focus on interaction between parts of the system and holistic patterns |
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Double bind
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inability to leave or commit due to a conflict of contradictory messages
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Dyadic
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interaction between two persons or objects
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Enmeshment
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Minuchin
-loss of autonomy blurring of psychological poundaries |
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Fusion
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blurring of psychological boundaries between self and others
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Helen Kaplan
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guru of sexual dysfunction treatment
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Multiple impact theory
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MacGregor
-Intensive, crisis-oriented form of family therapy -team therapy |
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Mystification
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Laing
-distortion of children's experience by denying or relabeling it |
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Object relations
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ones mode of relating to others, as determined by parent-child interactions early in life
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Premack principle
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use of high probability behavior (preferred activities) to reinforce low probability behavior
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Propinquity
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Means nearness or proximity
-theory of mate selection -proximity is a major factor in mate selection |
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Sculpting
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Duhl
placing family in postures that state their role |
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Triangles
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Nichols
Three person system smallest stable unit of human relations |
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Triangulation
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detouring of a conflict between two people by involving another person
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