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113 Cards in this Set
- Front
- Back
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Properties of a Family System |
-set of rules -assigned and ascribed roles for its members -an organized power structure -intricate covert and overt forms of communication -numerous ways of negotiating and problem solving that permits various tasks to be performed effectively |
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Fundamental Concepts of Family Systems |
-The relationships between family members are strong and last a lifetime. Divorce may impede relationships, but the bonds remain with co-parenting and recognition of former marriage. -People develop individual identities, but remain attached to the family group over the lifespan. -Families depend on one another for basic living necessities (food, shelter) as well as emotional support (love, companionship, socialization, fulfillment of long-lasting relationships). |
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"Enabled" family systems (Constantine, 1986) |
Balances family system needs while simultaneously operating on behalf of the interests of all its members as individuals. When problems arise, the members find ways to compromise solutions. This maintains a stable family system. |
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"Disabled" family systems (Constantine, 1986) |
This is an unbalanced family system where there is low differentiation of interests and problems are not resolved through compromise. The family system is marked by unstable, rigid, or chaotic family patterns. |
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Types of families |
-Traditionally enter family through birth, adoption, or marriage. -There are heterosexual/homosexual relationships, later marriages, step-families, interracial coupling, foster parenting, informal kinship adoptions, and families created out of social class position -no longer defined by "legal" terms of kinship -different living arrangements, styles of living, and organizational patterns. |
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Family structure and interactive patterns |
-Families have their own strategies for coping with stress imposed from the outside or from within the family itself. -Families exchange social expectations with one another with nonverbal communication. They transmit expectations of behavior and family rules (transactional patterns). -shared family rituals (e.g., celebrations, christenings, bar and bat mitzfahs, graduations, weddings, funerals) are part of ongoing family patterns that help ensure family identity and continuity. |
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Family social constructions |
=Unchallenged views of reality created and perpetuated in conversation with one another, possibly carried over generations. -social constructions may act as blinders or restraint--limitations a family places on itself by its beliefs or values--that prevents its members from noticing others aspects of their lives or seeing other behavioral patterns. -construct a rationale for why undesirable behavior continues and how they have no alternative but to live their lives the way they do. |
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Family "resiliency" |
=the family's ability to thrive and maintain relatively stable psychological and physical functioning even under adverse conditions. Family transitions: retirement, divorce, remarriage, death, job loss, violent/life threatening experiences (rape, victim of a crime), natural disasters. -React with short or long periods of distress and may/may not lead to recovery...others are more resilient. |
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3 key processes in family resiliency (Walsh, 2003b) |
-consistent and positive belief system that provides shared values and assumptions so as to provide guidelines for meaning and future action (e.g., viewing disruptions as milestones on shared life passages, w/out assuming blame, and viewing a crisis as a manageable challenge). -the family's organizational processes (how effectively it organizes its resources) in reaction to stress--family remains flexible, open to change, and connected with one another when faced with distress. -a set of family communication-solving processes that are clear, consistent, and congruent and establish a climate of mutual trust and open expression among its members (maintaining a shared range of feelings, shared decisions, creative brainstorming). |
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Factors that lead to resiliency in families (Goldenberg & Goldenberg, 2002) |
-resilient families respect individual differences and separate needs of family members. they have mastered successful problem-solving strategies by developing reparative, resiliency enabling processes that promote endurance and survival. |
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Gender roles and family life |
-Barnett & Hyde (2001) found that stay at home fathers resent child care-giving role (i.e., "woman's job") and women who want to stay at home with the children may resent their role working outside the home. -Coltrane (1998) found that men prefer to carry out their role by working and women have a tendency to carry a false belief that they are bad mothers when they choose to work outside the home. -Families who carry an egalitarian attitude benefit more from combining work and family roles than do those with more traditional gender-role ideologies. |
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cultural diversity and the family |
Definitions of who is part of the "family" differs among cultures, and may involve extended family members, relatives, friends, ancestors/descendants, etc. |
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Psychopathology in family therapy |
Psychopathology or dysfunctional behavior can be seen as the product of a struggle between persons than the result of opposing forces within each of the participants. |
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Monad Dyad Triad |
Focus on individual processes and patterns of behavior = monad Therapeutic attention given to the relationship between two or more individuals = dyad or triad |
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Circular causality in family therapy |
=Dysfunction is not the result of 1 singular event (linear causality) but from several forces in a simultaneous manner. The forces are ongoing, interactive, mutually influencing family processes. -family processes affect individual behavior and individuals within the family system affect family processes in a recursive (repetitive; cyclical) manner. Every action provokes a circular sequence that in turn helps change the original action. |
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First Order Cybernetic View of Family Therapy Vs Second Order Cybernetic View of Family Therapy |
1st Order: Family therapist is the "outside expert", entering the family to observe, disrupt its customary interactive patterns, and design strategies to alter the family's self-defeating and repetitive patterns. 2nd Order: The therapist is part of the process necessary for change. The therapist has his/her own "reality" and creates a context for change through therapeutic conversation and dialogue in the family, changing the family's premises and assumptions. *The therapist is part of the change in the family dynamic. |
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Identified Parent (IP) |
=the family member with the presenting problem or symptom -In family therapy, when the IP comes in for help, his or her entire family were also hurting and require assistance. |
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Different perspectives of psychopathology in families |
Different models of family therapy consider the identified patients in different ways. Early family therapists believed the symptom itself acts to stabilize the system and relieve family stress. Others viewed symptomatic behavior more as a reaction to family stress than as a protective solution to restore family balance. In another view, it is the repeated but unworkable solutions that become the problem. From a postmodern perspective, breaking with traditional cybernetic notions, symptoms are seen as oppressive, and the family is urged to unite to take back control of its members' lives from those burdensome symptoms. |
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Transgenerational Approach to Family Therapy |
-Offers a psychoanalytically influenced historical perspective to current family living problems by attending to family relational problems over decades. -Current family patterns are embedded in unresolved issues in the families of origin; repeated patterns spans over generations. |
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Bowen's Family Systems Theory (Also called "natural systems theory") |
-the family is an emotional unit, a network of interlocking relationships, best understood when analyzed within multi-generational or historical framework. -looks at the push and pull between family members for togetherness and individual autonomy. The goal is for the individual to differentiate himself from the family in a balanced manner and be able to maintain intimacy with loved ones while differentiating themselves sufficiently as individuals. -not based on cybernetic approach to family therapy, but analyzed the "family's emotional system" (evolutionary perspective of families) |
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Bowen's 8 Concepts of Family Systems Theory |
1. Differentiation of self 2. Triangles 3. Nuclear family emotional system 4. Family projection process 5. Emotional cutoff 6. Multigenerational transmission process 7. Sibling position 8. Societal regression |
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"Chronic Anxiety" in Bowen's Family System's Theory |
Chronic anxiety ties all 8 concepts together with an underlying premise that it is always present in life. It is a biological phenomenon that humans have in common with all forms of life. Anxiety is aroused when families struggle to balance the pressures toward togetherness and individual differentiation. -If the family focuses on increasing togetherness, then an individual in the family may experience chronic anxiety because they are not able to reach personal autonomy. (vice versa) |
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1. Differentiation of Self |
= the separation of one's intellectual and emotional functioning; the greater the distinction, the better one is able to resist being overwhelmed by the emotional reactivity of his or her family, thus making one less prone to dysfunction.
This concept is demonstrated by the degree to which a person think, plan, and follow his or her own values or convictions, particularly around anxiety provoking issues, without having their behavior automatically driven by the emotional cues from others. -Therapist should encourage the individual to speak in "I"-statements to show how they feel. |
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Symbiosis |
=an intense attachment between 2 or more individuals, (such as the mother and child) to the extent that the boundaries between them become blurred and they respond as one. |
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Fusion |
An individual who unable to differentiate thoughts from feelings, as well differentiate themselves from others. They merge easily with the emotions that dominate or sweep through the family. Become handicapped from differentiating self from family and have difficulty becoming an effectively functioning human being. become emotionally "stuck" in their lives with family dysfunction. |
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Undifferentiated family ego mass (also known as "Fusion Differentiation") |
=an intense, symbiotic nuclear family relationship; an individual sense of self fails to develop in members because of the the existing fusion or emotional "stucktogetherness." The family become so close to one another that the intimacy transforms into "overcloseness", leading to mutual rejection between members of the family. This occurs when emotional tensions shift over time in a series of alliances and splits. |
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Solid Self vs Pseudo Self (Differentiation of Self Scale) |
Solid self: (high differentiation) Express convictions and clearly defined beliefs. Does not compromise self to make others comfortable or to please others. "This is who I am"; "This is what I will do, but not this"; "these are my opinions on the matter" Pseudo Self: (low differentiation) Emotionally fused to the thoughts and feelings of their families. They experience anxiety and are stressed into dysfunction. They are fearful and emotionally needy; sacrifice their individuality in order to ensure acceptance from others. |
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2. Triangles |
= a three person system, the smallest stable emotional system; according to Bowen, a two-person emotional system, under stress, will recruit a third person in to system to lower the intensity and anxiety and gain stability. As more people become involved, the system may become a series of "interlocking triangles." As a rule: -The higher degree of family fusion, the more intense and insistent the triangulating efforts will be. -If there is a high degree of differentiation, the individual will be able to manage anxiety without following triangulating process. Example: therapist has a divorcing couple bring in their child into a therapy session to see their perspective of the relationship. later on the child makes a statement about relationship which mother agrees to. The therapist must not conform to the new triangle that the mother and son are trying to make with the therapist. |
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3. Nuclear Family Emotional System |
=an unstable, fused family's way of coping with stress, typically resulting in marital conflict, dysfunction in a spouse, or psychological impairment of a child; their pattern is likely to mimic the patterns of past generations and to be repeated in future generations. This family nuclear system will most likely experience anxiety and instability, leading to expression of anger through fighting, distancing, exploiting the impaired or compromised functioning of one partner, or banding together over the concern for a child. |
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3 symptomatic patterns in a nuclear family when partners are intensely fused (Kerr & Bowen, 1988) |
1. physical or emotional dysfunction in a spouse --in avoidance of conflict in the family, the anxiety generated by undifferentiated members is being absorbed by the symptomatic parent. 2. overt, chronic, unresolved marital conflict --roller coaster of emotions felt by the fused couple include the need for closeness and distance; family anxiety absorbed by the married couple. 3. psychological impairment in a child --the parents focus their attention on the child and ignore or deny their own lack of differentiation. The couple forgets about their relationship and the family's anxiety becomes absorbed by the child's impaired functioning. |
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4. Family Projection Process |
=the mechanism by which parental conflicts and immaturities are transmitted, through the process of projection, to one or more of the children. Child-rearing parents unconsciously pass on their levels of differentiation onto their children; kids adopt high, moderate, or low levels of differentiation. In a highly fused family, the youngest child is often the one who adopts the parents low levels of differentiation. This transmission process is called the family projection process. The child become physically or mentally handicapped or psychologically unprotected; become poorly undifferentiated and unable to act autonomously in the future. |
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5. Emotional Cutoff |
= a flight from unresolved emotional ties to one's family of origin, typically manifested by withdrawing or running away from the parental family, or denying its current importance in one's life. -Children less involved in the projection process have an greater ability to separate selves from the fused family. Once they become an adult, they may move to another state or cease communication with family members. This does not solve the problems and actually intensifies the emotional processes. Occurs mostly in families with high anxiety and emotional dependence. Emotional cutoff is completed by the individual out of the need for self-preservation. |
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6. Multi-generational Transmission Process |
=the process, occurring over several generations, in which poorly differentiated persons marry similarly differentiated mates, ultimately resulting in offspring suffering from schizophrenia or other severe mental disorders. People tend to marry partners with similar levels of differentiation and through the project process, future generations may adopt similar level of low differentiation; this is passed down from generation to generation. Offsprings have difficult time maintaining autonomy and managing emotional reactions. |
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7. Sibling Position |
= the birth order of children in a family, which influences their personalities and interactions with future spouses. The more closely a marriage duplicates one's sibling place in childhood, the better its chance for success. People who also grew up with a sibling with an opposite gender also have better chance of a successful marriage. Birth order predicts roles and functions people play in marriages. For example, if the youngest child marries someone who was the eldest child, they will look to partner to make decisions in the marriage (just like they did growing up with siblings). |
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8. Societal Regression |
=Bowen's notion that society responds emotionally in periods of stress and anxiety, offering short-term "band-aid" solutions, rather than seeking more rational solutions that lead to greater individuation. |
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Family System's Therapy: Evaluation Interview |
1. Do not become drawn into the family's emotional system by over-responding to the caller's forceful, charming, or theatrical presentation of the problem. (Avoid becoming fused with family) 2. Do not take sides in disputes, become over sympathetic with one member, or angry with another member. (Avoid triangulation) 3. The therapist may show interest in the family's problems, but should not become over-involved emotionally. You are there to develop differentiation among members. 4. Objectivity should characterize therapist's behavior in session. 5. The more a therapist has worked on become differentiated from his or her own family of origin, the more the therapist can remain detached , unswayed and objective. |
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Things to look for in the initial interview |
1. What is the relationship system like in this family? 2. What are the current stressors? 3. How well differentiated are the family members? 4. What is their adaptive level? 5. How stable is the family and how (and how successfully) does it handle anxiety? 6. What 3-person (or more) triangles exist? 7. Are emotional cutoffs operating? Also interested in the historical patterns of family emotional functioning, the family's anxiety levels at varying stages of its life, and the amount of stress experienced in the past compared with current functioning. In addition, explore whether one spouse's functioning has improved significantly (and other spouse declined significantly) over the course of the relationship. |
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Last part of evaluation interview |
Look at: 1. the multigenerational patterns of fusion 2. the nature of the nuclear's family's relationship with extended families 3. degree of emotional cutoff of each spouse. 4. Are there parallels in relationship patterns between the husband and wife and his or her parents? (may indicate levels of differentiation) |
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Genogram |
1. diagram the family over at least 3 generations 2. Biological, kinship, and psychosocial makeup can be gleaned from the genogram. 3. Identify members of the family, names, ages, siblings positions, marital status, divorces, separations, adoptions, etc. 4. Also: religious affiliation, work histories, ethnic origins, geographical locations, socioeconomic status, health issues, significant life events are also charted. |
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Contextual Therapy (Ivan Boszormenyi-Nagy) |
Focuses on the intrapsychic and inter-generational issues within families, especially with the subjective sense of claims, rights, and obligations in relation to one another. balance entitlement (what one is due or has come to merit) and indebtedness (what one owes to whom). Patterns of relating within a family are passed down from generation to generation; the patterns re key to understanding individual and family functioning. |
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Relational Ethics |
=in contextual family therapy, the overall, long-term preservation of fairness within a family, ensuring that each member's basic interests are taken into account by other family members. This encompasses: -individual psychology (what transpires within the person) -system characteristics (roles, power alignments, communication sequences within the family). |
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invisible loyalty |
=in contextual therapy, a child's unconscious commitment to help the parents, often to their own detriment (i.e., become the family scapegoat). |
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family ledger |
Every family maintains a family ledge, or multigenerational accounting system of what has been given and who, psychologically speaking, still owes to whom. |
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family legacy |
Reflects expectations handed down from previous generations concerning what is expected of, say men and women and family loyalty. This created child allegiances to parents. Fair and equitable parental behavior engenders loyalty in children Unfair demands and exaggerated sense of obligation may produce invisible loyalties in which the child unconsciously continues endlessly until the debt is paid off to the parents. The child harms themselves in the long run ans the debt takes priority over the themselves. Example: One child may be expected to achieve in school while other child is expected to fail. Legacy dictates the debts and entitlements to the family. |
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Obligations |
Obligations may be rooted in past generations and need not be consciously recognized or acknowledge to influence the behavior of family members in the present. |
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Therapeutic Goals Contextual Therapy |
Goal: improve family members' capacity for relatedness, re-balancing the give and take and emotional ledgers between family members. The therapist helps families reopen the claims of who owes what to whom, help members regain balance, fairness, and trust in relationships. Does the family negotiate the imbalances and maintain accountability and fairness during the process? Individual autonomy cannot be achieved without genuine consideration of others |
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Structural Family Theory |
-preference for contextual focus on problems and solutions (not individual focus) -uses spatial and organizational metaphors when describing problems and identifying solutions. -the therapist actively directs the session. 3 tenets of Structural Model: 1. An individual's symptoms are best understood as rooted in the context of family transaction patterns. 2. Change in family organization or structure must take place before the symptoms are relieved. 3. The therapist must provide a directive leadership role in changing the structure or context in which the symptom is embedded. The therapy emphasizes the: -wholeness of the family system -the influence of the family's hierarchical organization. -the independent functioning of its subsystems. |
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Transactional patterns |
Transactional patterns make up the structure of a family. A family's structure is the covert set of functional demands or codes that organize the ways family members interact with one another. The structure of a family provides a framework for understanding those consistent, repetitive, and enduring patterns that reveal how a family organizes itself in order to maintain stability and seek adaptive alternatives. patterns are self perpetuating and resistant to change. Resist change until a family experiences tension and imbalance in the system. |
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Types of Transactional Patterns |
Transactional patterns regulate the behavior of its members and are maintained by the following constraints: generic--universal rules; hierarchy of family members idiosyncratic --individualized rules; applies to specific families and involves mutual presumptions of particular family members regarding behvaior toward one another. complementarity--takes the form of teamwork in well-functioning families (e.g., couple working together). |
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Family Subsystems |
Families organize themselves into subsystems, often in hierarchical order: Gender (male/female) Generation (parents/children) Common interests (intellectual/social) Function (who is responsible for what chores) Subsystems are components of family structure. They exist to carry various family tasks necessary for functioning of the overall family system. Complemtarity of roles are key. Subsystems are marked by boundaries--who is in the system and who is an "outsider". |
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Examples of Family Subsystems |
Spousal Subsystem: indicative of family stability, flexibility, and adaptability to changing circumstances. -How does the husband and wife learn to negotiate differences? how do they accommodate each others needs?How do they develop complementary roles? Parental Subsystem: How does the couple handle new parenting responsibilities together? How do they complement each others parenting roles? How does the couple negotiate differences in parenting attitudes and styles? Sibling Subsystem: How do the siblings learn to support, cooperate, and protect each other? how do the siblings deal with competition, arguments, and negotiations with one another? When the family structure with its subsystems is flexible enough to meet ongoing family developmental circumstance = functional. When the family cannot adjust to changing circumstances = dysfunctional. |
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Permeability |
= The ease or flexibility with which members can cross subsystem boundaries within the family. |
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Types of Boundaries |
1. Clearly defined boundaries (well functioning family)--can help maintain separateness and emphasize belongingness to the overall family system. Provides support, easy access for communication/negotiation between subsystems, while encouraging independence and the freedom to experiment by members of other subsystems. 2. Rigid or Inflexible Boundaries (disengagement)--lead to impermeable barriers between subsystems. The worlds of parents and children are separate and distinct. They do not enter each other's world. The children may become independent, but feel isolated and unsupported. 3. Diffused boundaries (enmeshment)--excessively blurred or indistict. The roles between parents are children are too enmeshed with one another. The parents are over involved in their children's lives and the children never learn independent thinking/behaving or learn how to maintain relationships outside the family. Difficult to develop sense of self/personal identity in adulthood. |
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Enmeshment |
= a family organization in which boundaries between members are burred and members are over-concerned and over-involved in each other's lives, limiting individual autonomy. --separation from the family may seem like act of betrayal --no self-development in family members; autonomy or differentiation is not encouraged --children may act like parents and parental control is ineffective. -excessive togetherness-->lack of separatness; members are overly alert to signs of distress; intrusion in thoughts/feelings of members is common |
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Disengagement |
= a family organization with overly rigid boundaries, in which members are isolated and feel unconnected to each other, with each functioning separately and autonomously and without involvement inn the day-to-day transactions within the family. --members function separately and autonomously but with little sense of family loyalty. --members lack capacity to be interdependent to to ask for support from others when needed. communication is strained and guarded. --family does not protect one another when in distress. --when family under distress--> no emotional support or response from family members. |
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Alignments |
= Clusters of alliances between family members within the overall family group; affiliations and splits from one another, temporary or permanent, occur in pursuit of homeostasis. --the ways members join together or oppose one another in carrying out a family activity. This refers to the emotional or psychological connections family members make with one another. |
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Power |
= influence, authority, and control over an outcome. --who has authority (who is the decision maker) and who holds responsibility (who carries out the decision). This shows the influence of each family member on an operation's outcome. |
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Triangulation |
= a process in which each parent demands that a child ally with him or her against the other parent during parental conflict. --alignment with other parent is seen as attack/betrayal and he child is in a no-win situation. |
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Coalitions |
= alliances or affiliations, temporary or long-term, between certain family members against others in the family. |
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Structuralists believe 3 things must occur in families in order to achieve desired outcome in family |
1. Clearly defined generational boundaries so that parents together form a subsystem with executive power. 2. Alignments between the parents on key issues, such as discipline. 3. Rules related to power and authority, indicating which of the parents will prevail if they disagree and whether the parents are capable of carrying out their wishes when they do agree. |
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Structural Family Therapy |
Goal: family has reached restructured itself and members relate to one another in non-pathological patterns. Change rules for dealing with one another--> changing family system's rigid or diffuse boundaries to achieve greater boundary clarity. Actively and directly challenge the family's patterns of interaction, forcing members to look beyond the symptoms of the identified patient and look at all their behaviors within the context of family structure. The aim is to help family change its stereotyped interactive patterns and redefine its relationships, thus aiding members to better deal with stress in their lives. |
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Structural Family Therapy (Stages) |
1. Joining and accommodating 2. Assessing family interactions 3. Monitoring family dysfunctional sets 4. Restructuring transactional patterns |
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Joining and Accommodating Stage |
The therapist begins the session by adjusting to the family's affective style. Act like how the family behaves (expansive, constricted, etc.) The therapist joins the family structure and accommodates to its style of interaction. Therapist uses Mimesis by imitating the family's manner, style, affective range, or content of the family's communication in order to solidify the therapeutic alliance with them. --therapist might relate a family experience ("I have an uncle like that.") or mimic a family member's behavior (take off a coat, sit in a particular position). --> builds trust in relationship with family. Therapist will make confirming statements, acknowledging what is positive about a family member or describing a negative characteristic of one member and absolving the individual of responsibility for the behavior. |
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1. Joining and Accommodating Stage Mimesis |
= a tactic used particularly by structural family therapists, who attempt to copy or mimic a family's communication and behavioral patterns in order to gain acceptance by the family members. |
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2. Assessing Family Interactions |
Look at the family's hierarchical organization, the ability of its subsystems to carry out their functions, the family's possible alignments and coalitions, the permeability of current boundaries, and its pliability or rigidity in meeting the needs of individual members as circumstances commands. Also look at how the family reacts to developmental changes and the occurrences of crises. --family mapping through use of structural map |
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2. Assessing Family Interactions Family mapping |
= an assessment technique used by structural family therapists to graphically describe a family's overall organizational structure and determine which subsystem is involved in dysfunctional transactions. --find information on organizational structure, boundaries, and behavioral sequences; tracks alliances, coalitions, conflicts, ways members group themselves during arguments. Find who are the nurturers, healers, and scapegoaters. |
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3. Monitoring Family Dysfunctional Sets Boundary Making |
= a technique of structural family therapists aimed at realigning boundaries within a family by changing the psychological proximity (closer and further apart) between family subsystems. *ask members to change their seats |
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3. Monitoring Family Dysfunctional Sets Unbalancing |
= in structural family therapy, a technique for altering the hierarchical relationship between members of a system or subsystem by supporting one member and thus upsetting family homeostasis. |
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3. Monitoring Family Dysfunctional Sets Tracking |
= a therapeutic tactic associated with structural family therapy, in which the therapist deliberately attends to the symbols, style, language, and values of the family, using them to influence the family's transactional patterns. "leading by following" technique: Dad mentions he does not like closed doors. Therapist tracks this statement by asking questions relating to home life. Finds out kids do not close doors and parents always leave doors open (no sex life). Door becomes a metaphor for the family's boundaries and ca be used as a restructuring strategy. |
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3. Monitoring Family Dysfunctional Sets Enactment |
= a facilitating intervention in which the family is induced by the therapist to enact or play out its relationship patterns spontaneously during a therapeutic session, allowing the therapist to observe and ultimately to develop a plan or new set of rules for restructuring future transactions. |
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3. Monitoring Family Dysfunctional Sets 3 phases during enactment: initiation, facilitation, and closing (Nichols & Fallenberg, 2000). |
Initiation: therapist encourages the members to talk and therapist removes self from the dialogue; they specify the conversation and physically position the members to face one another. Facilitation: therapist does not interrupt the conversation/allow them to talk; encourage conversation when it dwindles by asking them explain themselves and expand on their feelings Closing: therapist helps the clients gain insights on how to profit from the experience. Explain problematic dynamics that took place during the conversation; advise clients on how to improve communication;praise clients for expressing feelings and listening well; emphasize the need for continued dialogue. |
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3. Monitoring Family Dysfunctional Sets 3 phases of Enactment (Butler & Davis, 2004) |
3 phases: initiation, intervention, and evaluation --facilitating communication skills --redirecting relationship processes or patterns --restructuring relationships --facilitating attachment-oriented emotional disclosures *enactments should not be unstructured or free-flowing; this may worsen the clinical experience of volatile and reactive clients. --assessment |
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Dysfunctional Sets (definition) |
Minuchin conceived family pathology as resulting from the development of dysfunctional sets. This refers to the family reactions, developed in response to stress, repeated without modification whenever there is family conflict. This pattern is repeated whenever the family is under stress. |
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4. Restructuring Transactional Patterns |
Restructuring involves: --changes in family rules and realignments --changes in patterns that support certain undesirable behaviors --changes in the sequences of interaction. Do this by reframing the problem |
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4. Restructuring Transactional Patterns Reframing |
= relabeling behvaior by putting it into a new, more positive perspective (i.e., "your mom is trying to help" vs "She is intrusive."), thus altering the context in which it is perceived and inviting new responses to the same behavior. |
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anorexia nervosa |
= prolonged, severe diminution of appetite, particularly in adolescent girls, to the point of becoming life threatening. structural family therapy is effective treatment for this disorder. |
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Strategic Models |
-Uses active and straightforward therapeutic interventions to reduce or eliminate presenting family problems or behavioral problems. -uses series of directives or tasks with the family. These are aimed at changing repetitive interactive sequences that lead to cross-generational conflict. -no interpretation or relationship building; focus on behavioral sequences that lead to problems in family. -This therapy provokes the family to change the way they deal with one another. -Tools: tracking family patterns of interpersonal exchanges and assigning tasks to achieve therapeutic ends. |
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Communication Theory |
-Verbal and nonverbal communication -metacommunication: a message about a message, typically nonverbal (smile, wink, nod, shrug) , offered simultaneously with a verbal message that syructures, qualifies, or adds meaning to the message. -Look at what is occurring; not why it is occurring. -look at the process between and among family members; do not draw inferences about member's inner conflicts.
*strategist's therapist's way of viewing problems is to attend to the family's sequences of interactions and its hierarchy of interaction. (look at family rules-->interactive behavior) |
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communication patterns |
-the style or manner in which information is exchanged within a family |
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Complementary and Symmetrical relationships |
Complementary relationships: a type of dyadic transaction or communication pattern in which inequality and the maximization of differences exist (e.g., dominant/submissive) and in which each participant's response provokes or enhances a counter-response in the other continuing loop. Symmetrical relationships: a type of dyadic transaction or communication pattern characterized by equality and the minimization of differences; each participant's response provokes a similar response in the other, sometimes in a competitive fashion. |
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Punctuation |
=the communication concept that each participant in a transaction believes whatever he or she says is caused by what the other says, in effect holding the other responsible for his or her reactions. -complex repetitive interaction. |
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MRI Interactional Family Therapy |
-looks at semantic, syntax, and pragmatics of communication 1. "All behvaior is communication at some level." (verbal/nonverbal) 2. "Communication may occur simultaneously at many levels." (statements, gesture, body language, tone of voice, posture, intensity; contradiction of hat is said and behavior towards person). -All communication takes place on 2 levels: 1. surface content level and 2. metacommunication (qualifies what is said on the first level--facial expression reflecting actual feelings). 3. "Every communication has a content (report) and a relationship (command) aspect." (i.e., husband says that he is hungry and expects wife to prepare food for him...how does wife respond?) 4. "Relationships are defined by command messages." How does the family find stability (homeostasis) after change in family--unexpected teenage pregnancy, divorce, etc.) 5. "Relationships may be described as symmetrical or complementary." -symmetrical relationship: interactive patterns is based on equality -Complementary relationship: interactive patterns are oppositional 6. "Symmetrical relationships run the risk of becoming competitive." -symmetrical escalation: when dialogue/argument between 2 people becomes increasingly aggressive and vicious 7. Complemetart communication inevitably involves 1 person who assumes a superior position and another who assumes the inferior one. 8. Each person punctuates a sequence of events in which he or she is engaged in different ways. 9. Problems develop and are maintained within the context of redundant interactive patterns and recursive feedback loops. (struggle for power and control in relationship) |
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Pardoxical injunction |
= a communication to obey a command that is internally inconsistent and contradictory, as in a double bind message, forcing the receiver to disobey in order to obey. |
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First-order changes |
* Temporary or superficial behavioral changes within a system that do not change the structure of the system itself.
* Changes are linear, cosmetic--reflect good intentions; short-lived and arguments are likely to resume. |
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Second-order changes |
* Fundamental changes in a system's organization, function and frame of reference, leading to permanent change in its interactive patterns.
* Therapist helps the family alter its systemic interaction pattern and then reorganizes the system so it reaches a new level of functioning. * discard old family rules for new ones. |
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Therapeutic double bind |
a general term describing the variety of paradoxical techniques used to change entrenched family patterns. This is used to force a person , couple, family into a no-lose situation. |
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Prescribing the symptom (therapeutic double bind) |
= a paradoxical technique in which the client is directed to voluntarily engage in symbiotic behavior; as a result, the client is put in the position of rebelling and abandoning the symptom or obeying , thereby admitting it is under voluntary control. |
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relabeling (therapeutic double bind) |
= verbal redefinition of an event in order to make dysfunctional behavior seem more reasonable and understandable, intended to provoke in others a more positive reaction to that behavior. * attempts to alter the meaning of a situation by altering its conceptual/emotional context so that a situation is perceived differently. * relabeling emphasizes the positive and helps the family redefine disturbing behavior in more sympathetic or optimistic terms. This also helps to provide a new framework for looking at interaction. Goal: change the structure if family relationships and interactions. |
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MRI Brief Family Therapy |
--focuses on resolving problems that result from prior attempts to solve an ordinary difficulty. Look at the family rules/communication styles that maintain and perpetuate the problem. --interventions are directed at changing the rules that sustain the problem wants fixed. Once the problem is eliminated, the the therapist's task has been completed. *main focus of MRI brief therapy is on treating the solution, not treating the problem. *brief therapy= less than 10 session for treatment |
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3 types of misguided solutions |
3 ways families mishandle solutions, leading to bigger problems: 1. some action is necessary but not taken * ignore the family problem (pregnancy, loss of job, etc.* newly wed couple separates after marriage because marriage did not live up to the ideal as was fantasized before marriage. * choose 1st order change solutions rather than 2nd order change solutions |
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MRI Brief Therapy (Intervention) |
Since treatment is very brief, the therapist's main goal is to eliminate the problem in the family. The therapist "thinks small"/be satisfied with minor/progressive changes and encourages the clients to "go slow"/be skeptical of dramatic, sudden changes. Paradoxical techniques are used and the family usually works harder to prove the therapist wrong. --All family members do not have to be present in sessions. --therapist collects data on previously failed solutions so as to not repeat them --Tx goals, case plan, interventions formulated --one therapist is assigned to a family; other therapists allowed to watch sessions through one-way mirror and telephone the therapist with advice, feedback, suggestions-->faster tx --Therapists direct their efforts at helping families substitute new bx patterns (new solutions) to replace old ones. |
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Strategic Family Therapy (Hayley and Madanes) Symptoms in relationships |
a symptom is a strategy, adaptive to a current social situation, used to control a relationship when all other strategies have failed. The symptomatic person will deny control over behavior and instead say it is involuntary (i.e. blame emotional distance in relationship on headaches, other physical sx). --power and control are at the center of every relationship between couple or family unit. --conflict in relationship = a struggle to control he definition of the relationship (not to control the other person) --strategists define symptoms as interpersonal events , tactics used by 1 person to deal with another. the goal is to maneuver the client into developing other ways of defining the relationship so that the symptomatic methods will be abandoned. -- |
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Strategic Family Therapy (Hayley and Madanes) |
1. direct interventions at a specific presenting problem 2. identify ways problem is dealt with in the family/maintained 3. customize strategies (straightforward or indirect directives) designed to track and alter problem-related interactive sequences. *main goal is to alleviate the presenting problem, not find the meanings behind the conflict. *short-term therapy |
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Strategic Family Therapy (Hayley and Madanes) |
--Analyzes the family unit in triads/triangles --Looks at the hierarchies in the family--root of symptomatic behavior in family members --therapists avoid developing coalitions with family members --emphasize the positives in the family, usually through relabeling. Relabel previously dysfunctional bx as reasonable and understandable. |
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Strategic Family Therapy (Hayley and Madanes) The initial interview |
1. brief social stage: therapist create a cooperative and relaxed atmosphere while observing family interaction and trying to get all members to participate. Everyone should have a voice in therapy. 2. problem stage: Ask questions about presenting problem * --why do you seek help now?* what would each of you like to change? Quickly or slowly? * --do you wish to realize what is happening or just to change? * --are you willing to make sacrifices to change? * therapist notes how each family member views the presenting problem 3.interactional stage: the family discusses the problem aloud with one another, permits the therapist to observe any dysfunctional communication sequences, coalitions, problematic hierarchies, conflicts between any duos, etc. 4. goal-setting stage: determine the presenting problem that will be worked on in therapy. Create a contract that defines the goals and allows clients to measure change or progress in therapy. 5. task-setting stage: therapist assigned homework or directives to family members. |
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Use of Directives |
* Directives = assignments of tasks to be performed outside the therapy session
* Directives get people to behave differently so they will have different subjective experiences * Directives help to intensify the therapeutic relationship by involving the therapist in the family's actions between sessions. * Directives help therapist gather information--> therapist observes the family's reactions to suggested changes |
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Paradoxical directives: prescriptive and descriptive |
Prescriptive paradoxes: ask the client(s) to do something Descriptive paradoxes: relabel everything already being done by giving it a positive meaning or connotation. (relabel negative action as positive--husband chased wife with axe--> relabeled as a way for the husband to seek closeness with wife). |
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Paradoxical Interventions |
* The patient or the family is exposed to contradictory instructions. A situation is created that cannot be resolved by means of logic, but only by creatively changing one's internal map of the world (paradigm/model/map), or through second-order change.
* similar to "prescribing the symptom" technique * used by therapists with defiant/resistant families * should the individualor family resist the paradoxical intervention, the symptomatic behavior is given up and the problem is eliminated (and therapist retains power and control) * example: a couple fights unproductively--> instructed to go home and argue for 3 hours |
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ordeal therapy (prescriptive directive) |
* Client states the problem, commits to changing the symptomatic behavior even if suffering is required, and promises to follow the therapist's directives regardless of logic/relevance to presenting problem.
* The therapist instructs the client to carry out an unpleasant chore (e.g., cleaning) whenever the symptom appears during the day, making the distress of the consequences a greater hardship than the distress of the original symptom. |
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3 steps to design a paradox: Redefining , Prescribing, and Restraining |
* Redefining: intended to change the family's perception of the symptom. Relabel the symptom as a loving gesture the family uses to preserve stability. (e.g., anger = caring; suffering = self-sacrifice; distancing =way of reinforcing closeness)
* Prescribing:therapist words the prescription in a way that is brief, concise, and unacceptable so the family recoils from the instruction (they will want to rebel against directive). Example: "practice being depressed"; "continue being rebellious against parents"). Family members will press for change and the therapist will resist by bringing up possible difficulties that may arise. Therapist allows family to change despite difficulties. * Restraining: therapist warns family about repercussions when change occurs too quickly. Rationalize the need to make gradual changes (i.e., "change takes time and must be proceeded step-by-step, otherwise there is danger of relapse if too much change occurs too fast.") The tactic prepares the client for change, acknowledges their reluctance to change, and solidifies change once it begins. |
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Systemic Family Therapy (Milan Model) |
A Milan-model therapeutic approach in which the family, as an evolving system, is viewed as continuing to use an old epistemology that no longer fits its current behavior patterns; the therapist indirectly introduces new information into the family system and encourages alternative epistemologies to develop. |
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The Milan Systemic Model |
* Questions family belief systems
* families become more aware of repetitive beliefs and behavioral patterns; family members see themselves within relational context (from the pov of fellow family members). * each family member is able to examine various perspectives with which to address problems. |
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Systemic Family Therapy--Milan Model "prescribing no change" |
Therapist begins by "prescribing no change" in behavior. Believe all family attitudinal and behavioral patterns are moves designed to perpetuate the family game and cannot be confronted or challenged head-on. |
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Systemic Family Therapy--Milan Model Counterparadoxes |
=placing the family in a therapeutic double bind in order to counter the members' paradoxical interactions. = therapeutic double-binds (e.g., warn against premature change--> family members feel more acceptable and unblamed for symptoms). |
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Systemic Family Therapy--Milan Model Positive Connotation |
= reframes the family's problem-maintaining behavior so that symptoms are seen as positive or good because they help to maintain the system's balance and facilitate family cohesion/well-being. Example: the "out of control" child is given positive connotation of having good intentions and "behaving volitionally." |
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Systemic Family Therapy--Milan Model Rituals |
Rituals are aspects of family relationships the therapist/team hypothesizes as significant for family functioning, based on how the teams views the family's current difficulty. Rituals may be ceremonial acts or routines in the family system. =symbolic ceremonial prescriptions offered by the therapist, intended to address family conflict over its covert rules, to be enacted by the family in order to provide clarity or insight into their roles and relationships. |
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Systemic Family Therapy--Milan Model Therapeutic interview format |
1. pre-session
2. the session 3. the intersession--break during the session 4. the intervention(usually a prescription or ritual) 5. the post-session--designed to evaluate the family's response to the interventions and plan the next session. *this is a long brief treatment--1x/month for 12 months. *uses a team of therapists (male and female) and a one-way mirror. |
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Systemic Family Therapy--Milan Model Hypotheses |
= a continual interactive process of speculating and making assumptions about a family situation. Takes the form of systemic or relational statements that link all family members and thus establish circular structure regarding family rules and interactive behaviors. * The technique allows therapist to search for new information, identify connecting patterns that sustain family behavior, and speculate on how each participant in the family contributes to systemic functioning. * Hypotheses are built to elicit a picture of how the family is organized around the symptom or presenting problem. * goal: change, not truth |
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Systemic Family Therapy--Milan Model Neutrality |
* the therapist's efforts to remain allied with all family members; does not get mired in family coalitions or alliances
* the therapist accepts each member's unique perception of the problem. |
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Systemic Family Therapy--Milan Model Circular Questioning |
* An interviewing technique, aimed at eliciting differences in perception about events or relationships from different family members, particularly regarding points in the family life cycle when significant coalition shifts and adaptations occurred.
* this technique involves asking each family member questions that address a difference to define a relationship between 2 other members of the family. * intended to reveal the different perspectives of family members and to expose recursive family patterns. * therapist constructs a map of interconnections among family members and assumes that asking questions about differences in perceptions is the most effective way to create the map. |
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Post-Milan Systemic Family Therapy--Boscolo and Cecchin |
* use a collaborative therapeutic intervention style based on the Milan interviewing style (circular questioning).
* Therapist listens to the differing views of the presenting problem and each member is helped to see his or her own behavior in a relational context, rather than from a linear or narrow self-centered perspective. |
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Post-Milan Systemic Family Therapy--Karl Tomm Reflexive Questions (definition) |
= designed to help families reflect on the meaning they extract from their current perceptions, actions, and belief systems, stimulating them to consider alternative ways to think and behave. * there are 8 groups of reflexive questions * Karl Tomm has concentrated on helping individuals and families bring out their healthy interpersonal patterns and replace pathologizing interpersonal patterns. |
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Post-Milan Systemic Family Therapy--Karl Tomm Reflexive Questions |
1. Future oriented questions: designed to open up consideration of alternative bx in the future ("if the two of you go t along better in the future, what would happen that is not happening now?")
2. observer-perspective questions: intended to help people become self-observers. ("how do you feel when your wife and son argue") 3. unexpected counter-change questions: opening up possibilities of choices not previously considered by altering the context in which bx is viewed. ("what does it feel like when the 2 of you are not fighting?") 4. embedded suggestion questions: allowing the therapist to point to a useful direction. ('what would happen if you told her when you felt angry or hurt instead of withdrawing?") 5. normative-comparison questions:suggesting problem is not abnormal. ("Has anyone else you know experienced this...?") 6. distinction-clarifying questions: separating the components of a bx pattern. ("which would be more important to you--showing up your boss's ignorance or helping him so the project can be successfully completed?") 7. questions introducing hypotheses: using tentative hypotheses to generalize to think outside bx with others. ("you know how you become silent when you think your husband is angry with you? what would happen of next time you told him how you felt.?") 8. process-interrupting questions: creating a sudden shift in the therapeutic session. ("you seemed to get quiet and upset, and i wonder if you thought i was siding with your wife?") |
