Family Week 8 Structural Family Therapy - Goldenburg 10, Bray 24, Gehart 5

Clear Boundaries

"normal". Allow for the fulfillment of differentiation. The boundaries allow for contact as well as enough distance to maintain independence. "allow for close emotional contact with others while simultaneously allowing each person to maintain a sense of identity and differentiation"

Clinical Techniques o Accommodation

a general term referring to the adjustments a therapist may make to a family in order to achieve a therapeutic alliance with them shift in relating.

Exam prep

50 multiple, 5 essay questions. okay to rely on fellow students for the 5 essay questions You are going to want to read Bray and Stanton systemic and epiemistology/epistemological of psychology. They are in the question. You would understand that chapter Bray and Stanton Bowen family systems theory. Bray and Stanton: Margarate Fascinating stories of family theories Other two are based on class notes Bowen, Satir and Minuchin are on the test sysstym assumptions- double bind, schizo mothers, disengaged families. IP Cybernetics is. Satir's stances differentiation Use notes and the books to emphasize the notes. Guess these essays. 2 hrs and 15 minutes.

Diffused

Blurred -create enmeshed relationships. There may be a strong sense of closeness but at the expense of individuality. Symptoms may include: • Interrupting/speaking for one another; can be good for interacting with each other. otherwise it can be a hierarchical interaction. But this would be cutting people off and disruption of connection. Avoiding what you wanna say versus joining with you in what you wanna say. Shared meaning is where relationships thrive. • Mind Reading/Making assumptions- we beginning to know their intentions and we want others to know our intentions are always good and need the other to recognize it. We dont want to share our needs, that poses as a threat of vulnerability. We think we should not have to ask for what we want. • High levels of Protectiveness and Worry- break down boundaries. As we protect/worry about the other. unknowingly.. we believe my feelings are the feelings of my child. we parent away from our fears. Just focus on my work and let the kids be kids while implementing good parenting skills. • Demand respect/loyalty-Energy based.... at the exopense of individual needs - move toward and go with people we respect and be loyal because we feel connected. When it is demanded, you are diffusing the other causing as a dominant narrative • Feeling threatened by disagreements or Differences are perceived as threatening. Cautious of how different are we? Differences are minimized and loses individuality. "do not make a clear distinction between members, creating a strong sense of mutuality and connection at the expense of individual autonomy"

Boundaries

Invisible lines of demarcation in a family. They operate as rules "for managing physical and psychological distance between family members, for defining the regulation of closeness, distance, hierarchy and family roles." Important in structural therapy. "Structures." Where responsibilities lie. Push the children away do that can learn autonomy.

Detouring

a Process whereby stresses between spouses get redirected through a child so that the spouse subsystem gives the impression of harmony "We would get along if you kids would just stop fighting" "the pair hold a third family member responsible for their difficulties with one another, decreasing their relational stress."

Hierarchy

a boundary that differentiates the leader of an organization from the other members "parental hierarchy so that they know how to intervene" Effective - Head of household. Parental dyad to be hierarchical, children in subsystem, not equals. Insufficient - not enough hierarchy where boundaries are clearly marked. "Mom's arent maids, you can get that yourself." enmeshed boundaries. Excessive - No, you are not allowed to have an opinion or have your own feelings, feel what I feel or what I tell you to feel. "hen there is excessive hierarchy, the rules are developmentally too strict and unrealistic and consequences are too severe to be effective. In this situation, there is almost always a rigid boundary between children and parents. These parents need assistance in developing age-appropriate rules and expectations and in developing a stronger emotional bond with their children." These are dynamic. Any given moment, effective hierarchies and ineffective. What is the sx? what produces sx? Let's work in that hierarchy. FAmily brings in pathology and we make that pathology unnecessary

Coalition

a covert alliance between two family members against a third Good: Siblings against a rigid parent to get them to change Bad: Daughter triangulating with Father against Mother.. Not helpful, lining against the third for their destruction. "are alliances between specific family members against a third member. A stable coalition is a fixed and inflexible union (such as mother and son) that becomes a dominant part of the family's everyday functioning."

Triangulation

a process in which two family members demand that a third family member side with each against the other What they felt.. Validated that hurt, join them with that hurt, "is there anything I can do to help?" affirm them both "Whenever the child does side with one parent, however, the other views the alignment as an attack or betrayal, putting the child in a no-win situation. Every movement the child makes causes one or the other parent to feel ganged up on and assailed. Because the parents fail to work out the problems, a third person is brought in (similar to Bowen's concept of triangles) and becomes part of the interaction."

Clinical Techniques o Boundary Marking

a strategy in which the therapist reinforces appropriate boundaries and diffuses inappropriate boundaries by modifying transactional patterns "is a special form of enactment that targets overinvolvement or un-derinvolvement to help families soften rigid boundaries or strengthen diffuse boundarie" Change seats Closer or further Subsystem sessions Asking a family member to remain silent Highlight a boundary Block interruptions "represents an effort to create greater psychological distance between the enmeshed, bringing the marginalized closer and this begins to modify transnational patterns"

Clinical Techniques o Joining—

an accommodating maneuver in which the therapist establishes rapport with family members and temporarily becomes part of the family system "the process whereby the therapist builds the therapeutic alliance with all therapy participants, as individuals and as part of their system." "imitating the manner, style, affective range, or content of its communications in order to solidify the therapeutic alliance with them."

Disengaged Family

an extreme pattern of family organization in which members are so separate they seem oblivious to the effects of their actions on each other Not enough closeness where individual choices impact togetherness "function separately and autono- mously but with little sense of family loyalty. Interpersonal distance is great, the members frequently lacking the capacity to be interdependent or to request support from others when needed. Communication is strained and guarded, and the family's protective functions are limited."

Enmeshed Family

an extreme pattern of family organization in which members are so tightly locked that autonomy is impossible Really engages each other around power struggles. Reliant on eachother's emotional well-being and are overly sensitive to their stanzas, The togetherness impacts the individuality Bowen uses "fused". Keep that separate. "Subsystem boundaries in enmeshed families are poorly differentiated, weak, and easily crossed. Children may act like parents, and parental control may be ineffective. Excessive togetherness leads to a lack of separateness; members, overly alert and responsive to signs of distress, intrude on each other's thoughts and feelings." "overconcerned and overinvolved in each other's lives." " separation from the family an act of betrayal. "

Parental Child

an overly responsible child who has power and authority that more appropriately belongs to the parents Mother redirected all her needs and love from her child rather than her husband. She brought that from her family of origin,

Clinical Techniques o Restructuring—

any therapeutic intervention that confronts challenges a family and facilitates structural changes "involves orchestrating opportunities for individuals within the system to interact in new ways and includes three categories of techniques: working in the present (i.e., enactments), reframing (re-labeling), and shifting boundaries (bringing people closer together or pulling them further apart)." "reframing, changes the original meaning of an event or situation by placing it in a new context in which an equally plausible explanation is possible. The idea is to relabel what occurs in order to provide a more constructive per- spective," "Reframing usually involves removing the blame from one person (the identified patient) and "spreading" blame equally by describing how each person's response contributes to the problem dynamic. Once this is done, blame becomes a moot point." Like Dib's Mom's interpretation for his symptoms

Clinical Techniques o Unbalancing—

any therapeutic intervention that supports one member of the family, thus interfering with the homeostasis of the family system Reiterate a family member says... stop the family, "ohh can you repeat what you said." or sit next to the person that is having a difficulty putting words out. Subtley empowering them. Shifting interactional pattern. Kneel down next to the client and ask "may I talk for you?" takes pressure off of them but really talks with the spouse. Speaking through them to their spouse that is not hearing them. "to change the hierarchical relationships of the members of a subsystem" "is used for more extreme difficulties in hierarchy or when the identified pa-tient is being made a scapegoat. This intervention is used to realign boundaries between subsystems " "Therapists use their expert position to temporarily "join sides" with an individual who is being made a scapegoat or with subsystems that need to develop stronger boundaries by arguing their cause or helping to explain their perspective to others."

Rigid

create disengagement among the family members. Autonomy and/or freedom is valued over connection. • Reactions or concerns seem understated, "Lack of reaction and few repercussions, even to problems" • Members appear to operate with freedom "Significant freedom for most members to do as they please" • Few demands of each other, "or expressions of loyalty and commitment" • More parallel versus reciprocal interactions. "Consistently using parallel interactions (e.g., doing different activities in the same room) as substitutes for reciprocal interactions and engagement"

Generational Boundaries

invisible lines of demarcation between generations ___D___O___ C C C

Key Assumptions

o Goal—Change boundaries and hierarchies sufficiently to allow presenting problem to be unnecessary "Clearly defined generational boundaries so that parents together form a subsystem with executive power • Alignments between the parents on key issues, such as discipline • Rules related to power and authority, indicating which of the parents will prevail if they disagree and whether they can carry out their wishes when they do agree" "The structural therapist's task is to disentangle the pair from their automatic yoked reactions, helping each partner discover his or her individuality, power, and responsibility." o Dysfunction—assumes an inadequate structure in the family system o Symptoms—are a result of poor structure Structure of family's lives break down and the symptoms are varied, like alcoholism, neglect, acting out, lack of participation, isolation, Minuchin emphasized that the family was not able to cope with current development stage of family Structure is exposed for being rigid and causes dysfunction. The martial dyad determines the functionality of the family. "Clearly defined generational boundaries so that parents together form a subsystem with executive power • Alignments between the parents on key issues, such as discipline • Rules related to power and authority, indicating which of the parents will prevail if they disagree and whether they can carry out their wishes when they do agree

o Complementarity

over/underfunctioning, good/bad, push/pull, understanding/strict, logical/emotional, priest/police. Problem when these are rigid roles and lack of flexibility and to connect. Taking turns to be fun and strict. "Over time, these systemically generated roles become viewed as inherent personality characteristics that seem unchangeable. The more exaggerated and rigid these roles be-come, the less adaptable the individuals and family become. Structural therapists rec-ognize the mutually reinforced patterns and target the ones that need to change for members to grow."

o Isomorphism—

situations in which the structure of a larger system is similar to a family's structure. Principles that can work across the board "Dysfunctional structural patterns tend to be isomorphically (simi-lar in dynamic) replicated at multiple levels in the family's broader social system. For example, therapists may notice that a family with enmeshed boundaries be-tween the primary caretaker and children may also have an overly involved social worker."

Clinical Techniques o Enactment

the acting out of dysfunctional transactional patterns within the family therapy session, encouraged by the therapist. Observation of Spontaneous Interactions//"Use tracking and mapping. When talking with the family, the therapist closely follows both content and process, listening for the rules and assumptions that coordinate the family's interactions, such as demands for overconnected-ness, extreme disconnection, or hierarchical confusion, as well as strengths and resources." • Content and Process • Rules/Boundaries • Develop hypothetical structure Eliciting Transactions/ "The invitation for an enactment is issued in one of two ways: either the therapist directly asks the family to engage in an enactment or the family spontaneously starts an enactment of at-home behavior, usually in the form of an argument"/"explicit invitation to "show" the problem:" Redirecting towards Alternative Interactions/"This is the most important part. It really is not therapeutic to ask a family to start enacting problem behaviors if the therapist does not jump in and help redirect the behavior to clarify boundaries and hierarchies. How therapists redirect the interaction depends on the particular interaction that needs to be changed." • Interrupt family members interruptions • Face to face communication • Encourage connection and empathy • Rearrange the family seating to increase/decrease engagement • Encourage parental hierarchy ". Enactment: The therapist encourages family members to deal directly with each other in session, thus permitting the therapist to observe and modify their interactions. Problematic behavioral sequences are treated through enactments by examining established roles and encour- aging the adaptation of new ones that are based on more functional ways of acting. It is key that the therapist maintain therapeutic distance from the family so that the roles and behaviors can be observed, clarified, and modified."

Clinical Techniques o Intensity—

the degree of impact of a therapeutic message, selectively regulated by the therapist Deescalate to the level below arousal but engaged and present "3. Therapeutic Intensity: The therapist maintains a situation (through the enactment) of prolonged intense affect, repeated interventions, and pressure. The enactment is also followed with specific behavioral protocols such as, in the case of a lunch session treatment for anorexia, targeted weight gains." "intervention that use affect to create structural shifts in hierarchy and boundaries, especially when the family is having trouble "hearing" the therapist with other interventions" "Intensity involves turning up the emotional heat by using tone of voice, pacing, and word choice to break through rigid and stuck interactional patterns."

Clinical Techniques o Mimesis—

the paralleling of a family's mood or behavior, which solidifies therapeutic alliance. to fit in "Mimesis is directed at the family's style and affect, and involves therapist attempts to match the tempo, mood, and style of family member interactions as a way of blending in with the family." "imitating the manner, style, affective range, or content of its communications in order to solidify the therapeutic alliance with them."

Role of the Therapist

the use of self as a significant tool to intervene and relate/feeling their way through the family. Moving around the room, to create/recreate structure change "therapists must use themselves to relate to the family, varying from being highly involved to professionally detached (Minuchin & Fishman, 1981). They may be clearly detached from family interactions so that they can clarify boundaries or prescribe a specific intervention, maintain a moderate level of connection to coach the family in new interactions, or assume a fully engaged position by taking sides with one family member to "unbalance" the system (an intervention discussed later in this chap-ter). The therapist is highly flexible, adapting to each family's needs and cultural norms." "12. Distance: To effectively facilitate, therapists must carefully choose how best to posi-tion themselves in relation to each client: close, distant, or somewhere in between. 13. Expertise: Therapists should use their awareness of family dysfunctional patterns as well as facilitating therapeutic conversations. 14. Self: The self of the therapist is the primary tool for facilitating change, not the inter-ventions, and therapists need to learn how to challenge families to react to the self of the therapist." Recognize the family strengths, not view family as enemy, but where the family provides support, protection, and a foundation for its members.

Subsystems

units within a family, based on characteristics such as sex, age, or interest

o Family Mapping

—the diagramming of a family's organizational structure, boundaries, and patterns of interaction. Bad: boys and dad against the women, father supporting boys word over mother Good: Father and Mother work together with authority over children. Makes moves to create the family mapping that is powerful. Work marital dyad with kids in the room. Give voice to mom and implement healthy boundaries. "an organizing schema for understanding complex family interactive patterns—especially which particular subsystem is involved in per- petuating a problem—"