Generalist Midterm

Strategic Family Therapy:Plan

1. Defining a problem clearly and concisely 2. Investigating all solutions that have previously been tried 3. Defining a clear and concrete change to be achieved 4. Formulating and implementing a strategy for change

Formulation of Treatment Groups

1. Determining the need for group 2. Establishing group purpose - from agency and social worker's perspectives - from client's perspective 3. Deciding on leadership 4. Deciding on group composition 5. Open versus closed groups 6. Determining group size and location 7. Setting the frequency and duration of meetings Conducting a preliminary interview... 1. Orient potential members 2. Elicit client's prior group experiences 3. Elicit, explore, and clarify client's problems 4. Explore client's hopes, aspirations, and expectations 5. Identify specific goals the client wants to accomplish 6. Mutually develop a profile of client's strengths and attributes 7. Identify and explore potential obstacles and reservations 8. Ensure that screening is a two-way process Placement Considerations Meet with each candidate for group placement Assess the client's level of... - interpersonal functioning - impulse control - motivation - stability Structuring the Group Group Size: - the number of participants ought to be determined by the objectives of each group. - seven to nine members are most often thought to be small enough to allow for open discussion and attention given to individuals - the recommended size for educational groups is larger with groups as small as twelve or as large as thirty Meeting Days and Time: - the day and time of meetings will be adapted to the needs and wishes of the members as part of initial planning. - groups usually meet weekly for one to two hours - groups living in institutions may meet more frequently - as goals are achieved meetings can be tapered off Open or Closed Groups: - designations of "open" and "closed" pertain to the timing of admissions to the group - open groups are like a slice of life - birth, separation, marriage, and death. - open systems tend to simulate reality and provide transferability to real life situations - closed groups include only those members selected at the group's formation Group Rules: - a group that makes is own rules is more likely to abide by them and to apply sanctions as needed to reinforce them - individual beliefs and values should be considered in relation to group rules - rules should be few in number and include only those deemed essential to achieve the purposes of the group - some members may attempt to impose inappropriate rules on the group Formulating Group Guidelines Group Decision Making Additional group issues to address... - help-giving, help-seeking roles - visitors - new members - individual contacts with the social worker - member contacts outside of the group - care for space and cleanup - use of recorder - eating, drinking, and swearing - attendance - programming - touching Qualities of Group Facilitator - confidence - knowledge - spontaneity - integrity - trust - humor - empathy - active Listening - reflecting - clarifying - summarizing - facilitating - empathizing - interpreting - questioning - linking - confronting - supporting - blocking - assessing - modeling - suggesting - initiating - evaluating - terminating Stages of Group 1. Beginning: - group worker sets the stage - worker takes time to identify the purpose - clearly commit to the goals and procedures - members need to know what they can expect from the worker - this stage is characterized as a time to convene, to organize, and to set a plan - members are likely to remain distant or removed until they have had time to develop relationships 2. Middle: - almost all of the group's work will occur during this stage. - relationships are strengthened as a group so that the tasks can be worked on - problem solving is a term often used to describe this stage - group leaders are usually less involved - the leader may remind the group of their goals and rules and confront relationships that may be interfering with the overall purpose of the group 3. End: - marked by the accomplishment of the goals of the group, production of results, and the evaluation of the group's work - preparation for termination should begin with the first session - the worker will help members deal with their feelings associated with the termination of the group - help participants plan on ways to maintain and generalize the gains each member has made Cultural Considerations in Forming and Assessing Groups - awareness of personal stereotypes and preconceptions about diverse groups - knowledge about the diverse groups that he or she is working with and the special needs of those groups - awareness of which intervention techniques are apt to be effective with those groups and which are not Ethics in Practice with Groups 1. Informed consent 2. Confidentiality 3. Self-determination 4. Competence 5. Non-discrimination Negative Attributes of Groups - not for everyone - confidentiality - difficult to build trust - untrained facilitators - not enough time to meet everyone's needs - conformity vs. peer pressure

Development Tasks of Families

1. Identify who does and who does not belong to the system - for example extended family, and decipher family resources 2. Develop deep commitment to the unit as a whole and to the individual members which includes identifying personal responsibilities as well as sacrifices 3. Maintain open communication for the expression of needs, values, frustrations, disappointments and ideas 4. Appreciate and support the uniqueness of each member 5. Establish common philosophies, values and goals 6. Establish rules regulating conduct and relationships consistent with family values and goals 7. Dividing responsibility for the maintenance of family as an effective functioning unit

Strategic Family Therapy:Interventions

1. Reframing 2. Paradox 3. Restraining: Encourage the client to "go slow" or not to change too much 4. Prescribing: Clients are told to continue/embellish the behavior they complain about in the hopes that the family might rebel against the change or it can help by removing the dysfunctional attempted solution 5. Ordeals: Interventions in which clients are directed to engage in a mildly noxious activity each time they engage in the targeted symptomatic behavior 6. Pretend: Instructing a symptomatic person to pretend to exhibit his or her symptom, which reclassifies that symptom as voluntary and not really "real" 7. Positioning Techniques: Therapist accepts and exaggerates the client's stance on an issue

Understanding Families from a Clinical Perspective

A family can be conceptualized as a dynamic and transactional social system in which each of its constituent parts and subsystems interact with one another in a predictable and organized manner - the basic unit in [Western] society traditionally consisting of two parents rearing their children - families have their own cultural dynamics as well as their own family dynamics - families are social systems that interact with, and are influenced by other systems in the social environment Traditional Functions of Family - child bearing and rearing - intimacy - security Families offer companionship to members, an outlet for adult sexuality, procreation, economic cooperation, protection, and socialization - family is the core group in society - it is our foundation for culture - today families are no longer take on the traditional model - families often look different in terms of culture and sexuality - families have the critical role of providing members the experience of love - families have the responsibility for producing, nurturing, and socializing the next generation - children are taught how to love, share, defer gratification, to empathize, to help others and to negotiate conflict within the family - within our family unit we learn to function as adults and to become financially and emotionally independent - we learn to set goals, roll with the punches, collaborate, and have self-discipline

Strategic Family Therapy: Hierarchies

A goal of Strategic Family therapy is to help families reorganize into more functional systems with clear boundaries and generational hierarchies (Haley, 1976) - look for the malfunctioning hierarchies

Bowen Family Systems Therapy

According to Bowen, human relationships are driven by two life forces: 1. Individuality 2. Togetherness - we have a human need to be connected and need companionship while also needing independence - how successfully people recognize these polarities depends upon the extent to which people have learned to manage emotionality - according to Bowen, unresolved emotional reactivity to our parents is the most important unfinished business of our lives - Bowen was more committed to systems theory as a way of thinking rather than a set of interventions Important concepts in Bowenian theory: 1. Differentiation of Self: The capacity to think and reflect, to not respond automatically to emotional pressures (Kerr & Bowen, 1988) - the ability to be flexible and act wisely even while experiencing anxiety - this concept is also seen as an ego strength 2. Emotional Triangles: Most relationships are shadowed by third parties - triangles are often driven by anxiety - often, when two people have problems they are unable to resolve and often will turn toward a third person for sympathy - or the conflict will draw in a third person trying to help - if the third party's involvement is temporary or pushes the two people to work things outs, the triangle doesn't become fixed - if the third person stays involved, the triangle can then become part of the relationship - the involvement of a third person serves to decrease anxiety in the twosome by spreading through three relationships - undermines the relationship of the twosome and diverts energy elsewhere - these triangles can happen in most families; they become problematic when they become fixed - triangulation lets off steam but freezes conflict in place! 3. Multigenerational Emotional Processes: Emotional forces in families operate over many years and generations - lack of differentiation in a family can produce emotionally reactive children which can result in emotional over involvement of the parents or emotional cutoff from the parents, which in turn leads to emotional reactivity in new relationships - people with limited emotional resources tend to project all their needs onto each other - as this new fusion is unstable, we might see emotional distance, physical or emotional dysfunction, overt conflict or projection of problems onto children 4. Sibling Position: Bowen believed children develop personality traits based on their birth order 5. Emotional Cutoff: Describes how people manage anxiety in relationships - the greater the emotional reactivity in a family, the greater the likelihood of a cutoff - this can be done by moving away, avoiding intimacy or insulating themselves with the presence of third parties 6. Societal Emotional Processes: Looks at how society influences family functioning - such as sexism, class and ethnic prejudices Optimal family development according to Bowen is when family members are differentiated, anxiety is low and partners are in good emotional contact with their own families - since we tend to leave our homes in the midst of when our relationships with our parents are changing, we often bring unfinished business with us - Carter and McGoldrick (1999) describe the family life cycle as a process of expansion, contraction and realignment of the relationship system to support the entry, exit and development of family members According to Bowen, people tend to choose mates with similar levels of un-differentiation - no sense of self or a weak or unstable personal identity - what then follows often is marital conflict, dysfunction in one of the spouses, preoccupation with one of the children or a combination of all three - often the un-differentiation in families of origin are transmitted to marital problems which are then projected onto a symptomatic spouse or child

Solution Focused Family Therapy: Key Concepts and Interventions

All therapy is a form of specialized conversations - with SFBT, the conversation is directed toward developing and achieving the client's vision of solutions The following techniques and questions help clarify those solutions and the means of achieving them • Looking for Previous Solutions - SF therapists have learned that most people have previously solved many, many problems and probably have some ideas of how to solve the current problem - to help clients see these potential solutions they may ask, "Are there times when this has been less of a problem?" or "What did you (or others) do that was helpful?" • Looking for Exceptions; This is the major intervention - even when a client does not have a previous solution that can be repeated, most have recent examples of exceptions to their problem - these are times when a problem could occur, but does not - the difference between a previous solution and an exception is small, but significant - a previous solution is something that the family has tried on their own that has worked, but later discontinued. - an exception is something that happens instead of the problem, often spontaneously and without conscious intention - SF therapists may help clients identify these exceptions by asking, "What is different about the times when this is less of a problem?" • Present and Future; Focused questions vs. past-oriented focus) - the questions asked by SF therapists are usually focused on the present or on the future - this reflects the basic belief that problems are best solved by focusing on what is already working, and how a client would like their life to be, rather than focusing on the past and the origin of problems - for example, they may ask, "What will you be doing in the next week that would indicate to you that you are continuing to make progress?" • Compliments - compliments are another essential part of solution focused brief therapy - validating what clients are already doing well, and acknowledging how difficult their problems are encourages the client to change while giving the message that the therapist has been listening (i.e., understands) and cares - compliments in therapy sessions can help to punctuate what the client is doing that is working - in SF therapy, compliments are often conveyed in the form of appreciatively toned questions of "How did you do that?" that invite the client to self-compliment by virtue of answering the question • Inviting the Clients to Do More of What is Working - once SF therapists have created a positive frame via compliments and then discovered some previous solutions and exceptions to the problem, they gently invite the client to do more of what has previously worked, or to try changes they have brought up which they would like to try - frequently called "an experiment" • Miracle Question (MQ) - this unusual sounding tool is powerful in generating the first small steps of 'solution states' by helping clients to describe small, realistic, and doable steps they can take as soon as the next day - the miracle question developed out of desperation with a suicidal woman with an alcoholic husband and four "wild" children who gave her nothing but grief - she was desperate for a solution, but that she might need a 'miracle' to get her life in order - since the development of this technique, the MQ has been tested numerous times in many different cultures • Scaling Questions - scaling questions (SQ) can be used when there is not enough time to use the MQ and it is also useful in helping clients to assess their own situations, track their own progress, or evaluate how others might rate them on a scale of 0 to 10 - it is used in many ways, including with children and clients who are not verbal or who have impaired verbal skills - one can ask about clients' motivation, hopefulness, depression, confidence, and progress they made, or a host of other topics that can be used to track their performance and what might be the next small steps • Coping Questions - this question is a powerful reminder that all clients engage in many useful things even in times of overwhelming difficulties - even in the midst of despair, many clients do manage to get out of bed, get dressed, feed their children, and do many other things that require major effort. - coping questions such as "How have you managed to carry on?" or "How have you managed to prevent things from becoming worse?" open up a different way of looking at client's resiliency and determination

Goals of Bowenian Therapy

An opportunity for people to learn about themselves and their relationships and so they can take responsibility for their own problems - the Bowenian therapist uses active inquiry to help family members get past blaming in order to explore their own roles in family problems - the Bowenian therapist pays attention to process and structure - process being the patterns of emotional reactivity and structure being the interlocking network of triangles For a change to occur in the family system, the focus needs to be on the most important triangle in the family; the one involving the marital couple - the goals are to begin the process of de-triangulation and differentiation which will then affect the whole family system - this calls for increasing the parents' ability to manage their own anxiety and strengthening the couple's emotional functioning Increasing the ability to distinguish between thinking and feeling and learning to use that ability to resolve relationship problems is the guiding principle of Bowenian therapy - therapists ask questions to promote self reflection and they direct them at individuals rather than encouraging family dialogues - Bowen differed from many systems therapists in that he didn't believe meaningful change required the whole family being present - instead he believed that change can be initiated by individuals or couples who are capable of affecting the whole family - much effort is made on the therapist not becoming triangulated in the couples' process - focusing too much on content can be a sign the therapist has become triangulated Techniques in Bowenian Therapy - genograms; assessment is critical - process questions - relationship experiments - detriangling - coaching taking "I" positions - displacement stories

Corrective Emotional Experiences in Group Psychotherapy

As psychotherapy groups are social microcosms, there are many built in tensions - there is a lot of prep work that goes into choosing group members which we will review later in the semester The tensions have roots in our family or origin and WILL be displayed in the group setting - conflict, dislikes, and strong feelings will occur The *here-and-now* is critical - sharing the raw, honest thoughts and feelings about what's happening in the moment Per Yalom, there must be two conditions for the Corrective Emotional Experiences to occur in a psychotherapy group 1. the members must experience the group as safe and supportive so that true tensions can be expressed and people can really be themselves and 2. there must be dynamic engagement among the members and honest feedback to permit reality testing Facilitating group psychotherapy requires skilled clinicians who understand the dynamics of groups, family of origin dynamics and the ability to make it come alive

Psychoanalytic Family Therapy

As the family therapy field matured, family therapists took a renewed interest in the psychology of the individual - the revival of interest in psychodynamic thinking reflected changes in psychoanalysis that made it more attractive to family therapists, including growth of the more relationship-oriented object-relations theories, interpersonal models, and self psychology - currently psychoanalytic family therapists attempt to integrate depth psychology and systems theory into approaches that focus on the individual and the family system Although many of the early family therapists were analytically trained, most rejected the psychoanalytic model when they began working with families - today, psychoanalysis is represented in family therapy in a small but significant number of psychoanalytic family therapists and by a growing recognition that family members are not just parts of a system but complex personalities with conscious and unconscious conflicts of their own

Cognitive-Behavioral Family Therapy: Interventions

Behavioral family therapy is typically practiced as (a) parent training, (b) couples therapy, or (c) treatment of sexual dysfunction Operant Techniques such as shaping, token economies, contingency contracting, and time-out are frequently used with child and adolescent patients Respondent conditioning techniques involving a modification of physiological responses (e.g., systematic desensitization, assertiveness training, aversion therapies, and sex therapies), and cognitive/affective techniques (e.g., thought-stopping, rational emotive therapy, modeling, reattribution, and self-monitoring) are used more often when treating adults - finally, the outcome of treatment is assessed using empirical methods In the cognitive-behavioral framework, family relationships, cognitions, emotions, and behavior are viewed as exerting a mutual influence on one another, so that cognitive inferences are thought to evoke emotion and behavior - likewise, emotion and behavior influence cognition. - compatible with systems theory, the cognitive-behavioral approach to families includes the premise that members of a family simultaneously influence and are influenced by each other. - while CBT doesn't suggest that cognitive processes cause all family behavior, it does stress that cognitive appraisal plays a significant part in the interrelationships existing among events, cognitions, emotions, and behaviors

Couples Psychotherapy

Couples therapy usually involves an intense focus on improving the communication pattern within the couple - improving the marital functioning of the couple hood Couples bring their habits and routines with each other directly into the session - the therapist is involved in assessing, analyzing and intervening in ways to help improve the couple's functioning - unlike individual therapy, couples therapy involves the therapist entering the couple's way of life more directly - it is typically considered more intensive than individual therapy because both partners are invited to co-create the process of change

Experiential Family Therapy: Interventions

Experiential family therapists use a host of evocative techniques and structured exercises (use of touch, roleplaying, and attention to non-verbals) to create personal therapeutic encounters - all of these choices techniques are designed to promote emotional expression and expand experiencing. - first, experiential therapists raise the level of anxiety in the family, then they behave in alternately provocative and supportive ways in order to help families take risks to express honest emotion. - therapists are open, genuine, and highly active Experiential therapists can be divided into two groups with regard to use of therapeutic techniques 1. Employs structured devices, such as role playing, family sculpting, and conjoint family drawing to promote affective expression 2. Tends to rely on the force of their own personalities - Virginia Satir in particular was known for her use of touch, which she used to model tenderness, affection, and gentle firmness with children • Family Drawing - "draw a picture as you see yourselves as a family. Make sure everyone is in the picture. Make sure everyone is doing something." - encourages families to work together to create a complete image - can be used to warm up families and frees them to express themselves - drawing may disclose perceptions that haven't been previously discussed, may bring about insight • Family Sculpting - one family member arranges the others - graphic means of portraying each family member's perception of the family and his or her place in it • Family puppet interviews - ask one family member to make up a story using puppets - present and work through problems through use of metaphor - can highlight conflicts and alliances - limited to working with children, most adults resist expressing anything meaningful through this intervention • Role-Playing - experience to be real, must be brought to life in the present - encourage parents to fantasize and role play scenes from childhood - mother may be asked to role play what it was like when you were a little girl - father may be asked to imagine himself caught in the same dilemma as his son - if someone mentioned isn't present then may use the empty chair technique

Experiential Family Therapy: Family Relationships

Experiential family therapy was influenced by existential, humanistic, and phenomenological theories - the central value of experiential approaches is a commitment to individual awareness and self-expression - people should aim for personal fulfillment - families are treated more as groups of individuals than as systems - treatment is designed to facilitate emotional experiencing and help individual family members find fulfilling family roles for themselves - the result is an approach that is relatively atheoretical and offers little systematic conceptualization of family dynamics. Normal Family Development: Healthy families support individual growth in family members and permit, even encourage, a wide range of experiencing - these families allow for individuality as well as togetherness, and members are honest about their feelings and free to be themselves - parents in these families facilitate their children's development of healthy channels for expressing their emotions and drives - dysfunctional families resist feelings and blunt emotional responsiveness - spontaneous experiencing is considered essential for healthy family functioning (more than either problem-solving skills or a functional family structure) Healthy Families: Healing power of emotion - parents appreciate children, support their feelings, and trust their experience. - children are encouraged to express a full range of human emotions - emphasis on becoming authentic self - emotional accessibility and responsiveness Dysfunctional Families: Root cause of family problems is denial of impulses and suppression of feelings - locked into self-protection and avoidance - adhere rigidly to the rituals they establish - smoother emotion and desire - dishonest communication patterns include: blaming, placating, being irreverent, and being overly reasonable (detached)

Strategic Family Therapy: Family Rules

Family Rules operate to preserve family homeostasis - change to a symptomatic family is often seen as a threat to their homeostasis - according to strategic family therapy, once the presenting problem is improved, the underlying dynamic will reveal itself - for example, a kid's acting out might be to protect a parent from the parent's own depression or under- functioning Changing the Rules Reframing: Offering a different way of looking at a dynamic How can a therapist change the rules of a family... 1. Identify positive feedback loops that maintain problems 2. Determine the rules that support those interactions 3. Find a way to change the rules in order to interrupt the problem maintaining behavior

Assessment of Families

Family Stressors The definition of a family event stressor found in your readings is described as "anything that provokes changes or some aspect of change, such as boundaries, structure, goals, roles or values, each of which can result in stress". (McKenry and Price, 2000, p.6) - stressors have tended to be categorized as either normative ( for example marriage or the birth of a baby) or non-normative (for example, an accident) - another layer to the stress is whether the stressor changes the family system - normative stressors and life cycle transitions are a definite part of family life Stressors can also include internal family dynamics such as poor communication - stressors can also include external factors such as economic and racial discrimination - whether internal or external, both impact the family system - families are impacted by public policy, and poverty - how families cope with the stressors may depend on a number of factors including their resources, strengths, and resilience Systems Theory Views human behavior as a result of interactions between people and their social systems - in general, the system as a whole is greater than the sum of its component parts - systems can include any formal or informal grouping of people or organizations (i.e. family, school, government, agencies, etc.) - focus: Individual & environment as part of various systems - assumptions: Systems are interactive - systems exchange information and are impacted by other systems - when assessing family systems, a complete family assessment should include macro, mezzo and micro level factors - all families have a range of individual and group strengths that need to be identified during the assessment process

Family Systems Theory: Family Boundaries

Family boundaries serve to maintain order and give a sense of place and purpose within the family unit - they are the imaginary lines that separate members and sub-systems - boundaries operate in families and impact how they function - family boundaries define who's responsible for what, how parents and children interact, and how the family relates with the outside world - in the realm of family functioning, certain types of boundaries are better than others - they also serve to protect the system and regulate who is inside and outside the unit Three Types of Family Boundaries 1.Clear Boundaries: Highly functioning families have clearly defined boundaries in them - clear boundaries define the authority of the parents while allowing the children to develop as appropriate for their age - for example, a clear boundary for a 6-year-old , Reeve, is that he goes to bed at 8:00 p.m. each night - by setting this boundary, children are given a structure that enables them to feel secure in the world and get the rest they need 2. Rigid Boundaries: Rigid boundaries are found in families where the members are isolated from one another and communication has broken down - in these families, there is little respect for the individuality of the people in them - for example, a rigid boundary in this regard would have a child going to bed at 8:00 p.m. until they are 18 years old - in this scenario, there's no room for a voice or an allowance for individual growth. 3. Diffuse Boundaries: These boundaries are found in overly involved families - in these families, there's a blurring of the line between parents and children - parents act like their children's friends and children run the risk of becoming too involved with their parents - in the bedtime example, a child would be allowed to go to bed whenever he/she desired Families who function at the highest level are those who possess clear boundaries - clear boundaries allow for the age appropriate development of individual family members while promoting the wellbeing of the family unit - in short, there's a sense of "I-ness" that compliments and enhances the sense of "we-ness" Enmeshed or Disengaged Families Dr. Salvador Minuchin describes the opposite ends of a continuum of family dynamics, both of which are considered dysfunctional 1. Enmeshed Family: It is characterized by an unhealthy connectedness (co-dependency) and blurred boundaries which make it almost impossible for members to emerge with independent personalities - exhibits signs of smothering, over-sharing, and caring that reaches beyond normalcy - boundaries do not allow for individuation; they are too fluid, and have become crossed and often distorted - boundaries are constantly crossed in numerous ways. Disengaged Family: share little to nothing, typically overly rigid families, are described as detached - there's little to no communication - and no flexibility in family patterns to accommodate effective support and guidance - it is made up of parents and children who share basic needs, but little else - it is a family in name only and lacks intimacy and cohesion Familial Sub-Systems Every family system contains a number of small groups - these groups are usually made up of 2-3 people - the relationships between these people are known as subsystems, coalitions, or alliances - each subsystem has its own rules, boundaries, and unique characteristics - membership in subsystems can change over time 1. Sibling system 2. Parental system 3. Spousal system 4. Mother-child system Homeostasis and Equilibrium Refers to the tendency of a family system to maintain internal stability and to resist change - systems develop typical ways of being which are reliable and predictable - family roles & family rules are examples of this - whether these roles & rules are adaptive or not, there is a pull from the system NOT to CHANGE—but to continue functioning as things have always been - this tendency of systems to keep doing things as they've already been done is known as homeostasis or the system's equilibrium Family Roles These are defined as actual patterns of interaction with one another - each individual family member engages in familial roles - they are the individual expectations of each family member - the most basic types of roles are father, mother, aunt, daughter, grandmother etc. - what is expected from people in each of these roles? - there are also roles beyond this most basic level - for example, one person may be the "clown" of the family. Another person may be the "responsible one." One person may be the "emotional one." Another role might be "crazy uncle Joe" who everyone knows is going to act odd in his own unique way 1. Are the expectations shared by all family members? 2. Role competency: Does the member have the skill and knowledge to meet the expectations of the role? - for example, father being the bread winner if he is an alcoholic; oldest sibling caring for the younger ones. 3. Role ambiguity: Do people have a clear expectation of their roles? What does it feel like to them? 4. Role conflict: Differing expectations for different - for example, single mother being the bread winner but also having to be at all the school events, nurturer, house keeper etc. Family Rules Family rules are rules about how the family operates - families are governed by these rules which for the most part are unstated - often they have been developed and modified through trial and error over time - these rules are usually ingrained and are not talked about until one is broken - as social workers we want to assess whether these rules support or inhibit growth - families tend to develop patterns - these patterns become the "unspoken rules" - they may see these rules as "just the way it is" Open and Closed Systems 1. Open systems: Open to communication and receiving help from outside sources - these families are flexible and are free to move and interact with one another 2. Closed Systems: Enforce strict rules in a hierarchal and often patriarchal structure - here family loyalty is paramount - deviation from this structure can lead to chaos - closed systems are assessed in degrees - there is often a privacy issue in these families that is culturally driven Family Communication Styles 1. Congruent Style: The spoken words relate to the reality of what is felt - clarity exists between what is said and what is felt - both parties are clear about the message - lines of communication are open and mutually understood 2. Placating: Is a barrier to effective communication because the act of giving in, when you do not agree with the other person, tends to appease rather than serve to provide open and honest communication between two people - placating language might include telling the other person that they are right, and apologizing for disagreeing, even if you do disagree - avoiding conflict at the expense of assertive communication is placating -this person is usually highly motivated for peace. 3. Blaming: Judging, bullying, comparing and complaining 4. Passive Aggressive: Is a style in which individuals appear passive on the surface but are really acting out anger in a subtle, indirect, or behind-the-scenes way - these family members usually feel powerless, stuck, and resentful

Family Psychotherapy

Family therapists believe that the dominant forces in our lives are external - located in the family Therefore, family therapists believe that change must occur on the family level - often with the organization of the family The family is considered a system and changing a family's dynamics will change each family member - instead of isolating individuals from the emotional etiology of their conflicts and distress, family therapy addresses the problems at their source - the transformations in the family can have lasting ramifications for each member of the family The shift from an individual to a systemic perspective was quite revolutionary - certain dynamics forced therapists to recognize the family's power to affect change in an individual - therapists began to notice that often when someone in a family showed improvement and became healthier, someone else in that same family became more symptomatic - secondly, it was noticed that people improved in psychiatric hospitals, but once they returned home, there was decompensation and regression for the client When there was exploration to explore how to treat families, there was a parallel found in small group work - the *process/content* dynamic had a major impact on family therapy in that therapists began to attend as much to how people talk as to the content of their discussions - family process refers to verity of family functions to help the family as a system to adjust with new situations and needs - family content refers to family possession and family social context defines situational characters and social values and beliefs those hold a family - there are three types of family can be defined based on the two first dimensions (Family process and Family content): 1. healthy or efficient family, 2. unhealthy or inefficient family and, 3. problematic family After all, what is a family but a group of individuals? - groups and families share similarities - they are both complex and dynamic; more like everyday life However, the differences between groups and families is significant in that there is limited applicability to family treatment - families have way more history and have a future together - sharing with strangers can often feel safer than exposing yourself to members of your own family - continuity, commitment and shared distortions make family therapy quite different from group therapy Family therapy can benefit the family as a whole: - when the family is dealing with divorce, loss of a family member or some other major life disruption - when the family falls into unhealthy patterns of behavior that are difficult to change Family therapy is neither a 'cure‐all' nor a treatment of last resort, but an effective way of dealing with problems embedded in a dysfunctional family system - it may sometimes be usefully combined with the treatment of individual family members

Group Psychotherapy

Group therapy typically rests on the dynamic interactions of the members of the group - the emphasis is on helping members understand the projections they have toward other members, while learning from the feedback they receive from others, including the therapist Group psychotherapy involves recreating a smaller social microcosm that reflects real life and the difficulties clients may be experiencing in real life - the idea is that issues one has in life will often find their way to surface in the psychotherapy group - the group can be a safe place where members can see themselves and their actions in a safe environment, hopefully having new insights about themselves and their functioning in the world with others

Group Work

Groups instill hope and encouragement, universalize experiences, break down isolation and allow members to experience altruism and the satisfaction of helping others (Pack-Brown, Whittington-Clark, and Parker, 1998) - in groups, clients grapple with existential questions, learn coping skills for life experiences and experience healing through cohesion and mutuality - groups can provide a very powerful mechanism for change, whether they are used as the only intervention, or along with individual therapy, family therapy or other modalities Group work is a method of working with people in groups (two or more people) for personal growth, the enhancement of social functioning, and for the achievement of socially desirable goals - group work is a method of reducing or eliminating roadblocks to social interaction and for accomplishing socially desirable purposes - almost all social service agencies use group work - the social group worker uses their knowledge of group organization and functioning to affect the performance and adjustment of the individual - the individual remains the focus of concern and the group the vehicle of growth and change - enhancement of social functioning through the use of the group is the primary aim of group work Whatever the type of group the social worker leads, the SW must 1. Create a group that can effectively serve the purpose for which it was designed; 2. Accurately assess individual and group dynamics; and 3. Intervene effectively to modify processes that are affecting the group's achievements of its goals The success of the group often depends on the groundwork done prior to the first group meeting

Experiential Family Therapy: How it Works

Growth (not symptom relief) is the goal of experiential family therapy - this includes increased personal integrity (feelings and behavior are congruent), greater freedom of choice, less dependence, and expanded emotional experiencing - the underlying premise is that emotional growth is best promoted by liberating the affects and impulses of family members - family relations are revitalized by authentic interactions among members struggling to be themselves - if a family is brought together emotionally, children will feel a sense of belongingness and the freedom to individuate

Families & Social Work

How family is defined has an impact on clients and the services that they are able to receive How could a limited definition of family impact these types of families? - single parents - families in which grandparents are the primary caretakers - gay and lesbian families Social Work Approaches with Families 1. Family-centered practice is described as a collaboration between the family and the professional serving the family 2. Family can be seen as biological, legal, and/or chosen 3. In the case of family preservation, "family" is varied and each family should be approached as a unique system

Structural Family Therapy: Interventions

In general, structural family therapy often follows these steps: 1. Joining and accommodating 2. Enactment 3. Structural mapping 4. Highlight and modifying interactions (affective intensity) 5. Boundary making 6. Unbalancing: Therapist aims to realign relationships between subsystems 7. Challenging unproductive assumptions

Corrective Emotional Experiences

In this seminal book, Alexander and French introduced the concept of corrective emotional experience - the task of psychotherapy, in their view, was "to re-expose the patient, under more favorable circumstances, to emotional situations which he/she could not handle in the past - "the patient [...] must undergo a corrective emotional experience to repair the traumatic influence of previous experiences" (p. 66) Within the transference relationship, the client becomes able to master an unresolved conflict - in part because the conflict as presented in the transference is emotionally less intense than the original one, but most of all "because the analyst assumes an attitude different from that which the parent had assumed toward the child in the original conflict situation" (p. 66) The primary process is not about remembering but repeating, that is to say the reproducing of the emotional experience in the treatment - intellectual insight alone is not sufficient (p. 67) Initially this was criticized as it was often misconstrued as contrived and manipulative (i.e. the analyst would "stimulate" past experiences), however in current psychotherapies, the corrective emotional experience itself is considered a cornerstone of therapeutic effectiveness - it can be seen as the gold pot at the end of the rainbow The therapist does not recreate the patterns yet is aware and attuned to them when it presents themselves The *here and now* is critical to change - sharing the raw, honest thoughts and feelings about what's happening in the moment - experiencing disconfirmation of the client's beliefs - experiencing the felt feelings of when one realizes they have been operating on internalized distorted beliefs - experiencing, through reality testing, the inappropriateness of one's interpersonal reactions This can happen in individual therapy, family therapy (often with the therapist being the model/transference object) and it definitely happens in group psychotherapy

Family Systems Theory

Introduced by Dr. Murray Bowen in the 1950's - Bowen family systems theory is a theory of human behavior that views the family as an emotional unit and uses systems thinking to describe the complex interactions in the unit - it is the nature of a family that its members are intensely connected emotionally - often people feel distant or disconnected from their families, but this is more feeling than fact - family members so profoundly affect each other's thoughts, feelings, and actions that it often seems as if people are living under the same "emotional skin" - people solicit each other's attention, approval, and support and react to each other's needs, expectations, and distress - the connectedness and reactivity make the functioning of family members interdependent - a change in one person's functioning is predictably followed by reciprocal changes in the functioning of others - families differ somewhat in the degree of interdependence, but it is always present to some degree - overall, this theory suggests that individuals can not be understood in isolation from one another, rather as part of a unit - this organized unit consists of several factors that influence the individuals in the family - these factors are the structure or boundaries, rules, roles, open and closed systems and communication patterns Knowledge of how the emotional system operates in one's family, work, and social systems reveals new and more effective options for solving problems in each of these areas

Experiential Family Therapy: Assessment

Less interested in solving problems than in enhancing family functioning - pay limited attention to specifics of presenting problem - little interest in assessing the family structure or organization - diagnosis and assessment brings judgement and prevents therapist from emotionally connecting to individual or family - assessment is informal - develop relationship with each family member - Whitaker: would ask each family member to describe the family and how it works - to get a picture of each family member and their perception of the family The way to emotional health is to uncover deeper levels of experiencing - emphasize the feeling side of human nature: creativity, spontaneity, and the ability to play - in therapy, the value of experience for its own sake - therapist is alternatively provocative and warmly supportive - permits family members to drop protective defenses and open up to each other - the existential encounter - the essential force in the psychotherapeutic process. - a reciprocal process, therapist must be a genuine person who catalyzes change using their personal impact on families

Strategic Family Therapy:Goals

Primary goal is to resolve, remove, or ameliorate the problem the family agreed to work on (Snider, 1992) - learn how to address other problems in a constructive manner - altering destructive patterns of communication - emphasis is on process rather than content

Psychoanalytic Family Therapy: Interventions

Psychoanalytic therapists employ four basic techniques: 1. Listening 2. Empathy 3. Interpretation 4. Analytic neutrality - these techniques foster insight and facilitate the process of working through Conflict between couples is taken as the starting point for exploring intrapsychic and interpersonal dynamics - the analytic therapist helps partners explore their individual emotional reactions - why do they get so angry? - what do they want from each other? - what did they expect? - where do these feelings come from? - rather than trying to resolve arguments, analytic therapists interrupt to ask a series of questions about the fears and longings underlying it The red flag of intrapsychic conflict is affect - analytic therapists explore strong feeling and inquire into its roots in detail (what were you feeling? when have you felt that way before? what do you remember?) - rather than staying focused on the couple's current behavior, the therapist looks for openings into the depth of their internal experience and its history In sum, analytic therapists organize their explorations along four channels: 1. Internal experience 2. The history of that experience 3. How the partner triggers that experience 4. How the context of the session and therapist's input might contribute to what's going on between the partners Finally, it's important to keep in mind that there are several different approaches to psychoanalytic treatment - Freudian, which focuses on sexual and aggressive drives and defenses against them - Object Relations, which focuses on internalized distortions of self and other - Self Psychology, which focuses on the needs for admiring attention and idealizing

Psychoanalytic Family Therapy: Family and Romantic Relationships

Psychoanalytic therapists locate problems within people as well as between them - the origin of psychopathology is attributed to the development of distorted perceptions in childhood - manifest as "transference" and "projective identification" Projective Identification: A process whereby the subject perceives an object as if it contained elements of the subject's personality and evokes responses from the object that conform to those projections - projective identification is an interactional process - for example, parents project anxiety-provoking aspects of themselves onto their children, and then children collude by behaving in ways that fulfill their parents' fears More recent descriptions suggest that the critical determinants of poor adult adjustment are inadequate separation-individuation and introjection of pathological inner objects - failure to develop a cohesive sense of self causes an anxious emotional attachment to the family - anxious attachment to parents handicaps a person's ability to develop a social and family life of his or her own - this explains, in object-relational terms, the enmeshment that characterizes so many symptomatic families From a psychoanalytic perspective, one's choice of an intimate partner is based partially on the desire to find someone who will gratify unconscious fantasies - romantic choices are further complicated by the false-self phenomenon - a false self develops in insecurely attached children whereby they learn to hide their real needs and feelings to win approval - during courtship both partners are eager to please; however, once committed, mates reveal themselves, their powerful dependency needs, narcissism, and all - finally, romantic attraction is influenced by the mutual fit of the partners' projective systems - on some level, each wants the other to be an idealized parent in order to fulfill frustrated childhood needs Marriage, on a deeper level, is considered by psychoanalysts as a transaction between internalized objects - we all want our partner to conform to our inner expectations and we are anything but understanding when those expectations are disappointed (Dicks, 1963) - unmet needs

Solution Focused Family Therapy

Solution-focused brief therapy (SFBT), also called solution-focused therapy, was developed by Steve de Shazer, and insoo kim berg and their colleagues beginning in the late 1970's - as the name suggests, SFBT is future-focused, goal-directed, and focuses on solutions, rather than on the problems that brought clients to seek therapy - in SFBT, clients are viewed as having the necessary strengths and capacities to solve their own problems Solution-focused therapy works well with couples and familie - SFBT actually emerged from the family therapy field - solution-focused questions are asked of family members so that they can understand the way their behaviors influences others - it redirects the blaming and attacking stance of family members into request for the presence of positive behaviors - the focus turns to times when the hoped for behavior already occurs and what is different about that context - the focus leads to a more positive view of other family members which then leads to more positive behavior Solution-focused therapy shares many similarities with a generalist-eclectic framework. - it is applicable to a wide range of settings and problems with which direct practice social workers are involved (Greene & Lee, 2010), including crisis intervention and child protective services Described as a practical, goal-driven model, a hallmark of SFBT is its emphasis on clear, concise, realistic goal negotiations - the SFBT approach assumes that all clients have some knowledge of what would make their life better, even though they may need some (at times, considerable) help describing the details of their better life and - that everyone who seeks help already possesses at least the minimal skills necessary to create solutions - in general the past is de-emphasized other than times when exceptions to problems occurred

Strategic Family Therapy

Strategic Family Therapy grew out of communications theory Jay Haley has refined and mastered the technique of strategic family therapy - his approach is modeled after the therapy developed by Milton H. Erickson MD, one of the world's leading hypnotists and psychiatrists - as Haley wrote, "Strategic therapy isn't a particular approach or theory, but a name for the types of therapy where the therapist takes responsibility for directly influencing people" (Pg. 17) Strategic therapy has a fascination with strategies to outwit resistance and provoke families into changing without their cooperation - it is this very aspect, which appeared manipulative to many, that turned people off of Strategic Therapy However, there were two significant insights that came out of Strategic Family Therapy and its orientation 1. Families often perpetuate problems by their own actions 2. Directives tailored to the needs of each particular family can sometimes bring about quick changes There are different sub-schools of strategic family therapists - the roles of strategic therapists differ among their sub-schools However, they tend to... - share a belief in being active and flexible with their family clients - emphasize short-term treatment, about 10 sessions. "Brief therapists hold in common the belief that therapy must be specifically goal-directed, problem-focused, well-defined, and, first and foremost, aimed at relieving the client's presenting complaint" (Wylie, 1990) Strategic Family Therapists concentrate on the following dimensions of family life: 1. Family Life: The overt and covert rules families use to govern themselves 2. Family Homeostasis: The tendency of the family to remain in its same pattern of functioning unless challenged to do otherwise 3. Quid Pro Quo: The responsiveness of family members to treating others in the way they are treated

Structural Family Therapy

Structural Family Therapy is a framework that brings order and meaning to the transactions that occur within families - it involves looking at the overall organization of a family that regulates the family's transactions - exploring the subsystems and boundaries of families became a key insight of family therapy in general - structural family therapy introduced the idea of enactments; where family members are encouraged to deal directly with each other in sessions, permitting the therapist to observe and modify their interactions Salvador Minuchin is well known for leading the way in shaping structural family therapy - by the 1970's, structural family therapy had become the most widely practiced of all systems of family therapy - Families and Family Therapy (1974) by Minuchin became one of the most successful books of structural family therapy Three constructs define structural family therapy 1. Structure: Structure becomes evident only when a therapist observes actual interactions among family members 2. Subsystems: Based on generation, gender and function 3. Boundaries: Invisible barriers that regulate contact with others - interpersonal boundaries can vary from rigid to diffuse - rigid boundaries are restrictive and permit little contact with outside subsystems, resulting in disengagement - disengaged subsystems are independent but isolated - often fostering autonomy but limiting affection and support - enmeshed subsystems offer closeness, but at the expense of independence - initiative is often crippled Structural family therapists will often use symbols to diagram structural problems It is normal for families to experience anxiety and disruptions as their members grow and change - often times, the family is trying to adjust their structure to adjust to new circumstances - this is not pathological - healthy families will accommodate to changed circumstances - dysfunctional families will increase the rigidity of structures that are no longer working - disengaged families often fail to mobilize support when it is needed - enmeshed families are highly dependent on one another and intrusive parents can create difficulties by stunting the development of their children and interfering with their ability to problem solve on their own - usually it is particular subsystems that are enmeshed or disengaged.

Structural Family Therapy: Goals

Structural family therapy does not create new structures in the family but believes in activating dormant ones - a therapist produces change by joining the family, probing for areas of flexibility and then activating latent structural alternatives - the therapist has to be accepted into the family so that restructuring maneuvers can help transform the family structure - the use of enactments helps to reveal structural patterns and later to change them - this gets addressed in the immediate context of the session; the here and now - structural family therapy is not a set of techniques but rather a way of looking at families - every family has a STRUCTURE and this is revealed when the family is in action

Experiential Family Therapy: Development of Behavioral Disorders

Symptoms are the result of suppression of feelings and denial of impulses, which rob family members of flexibility and vitality - as a result, individuals are incapable of autonomy or real intimacy - the root cause is alienation from experience - experiential therapists look beyond interactions between family members to consider intrapsychic problems and "normal" problems (e.g., obesity, smoking, overwork, "lonely father syndrome," and "parentified child syndrome") in order to explain psychopathology

Cognitive-Behavioral Family Therapy: Development of Behavioral Disorders

Symptoms are viewed as learned responses, involuntarily acquired and reinforced - no underlying meaning of symptoms is sought, nor do behaviorists posit conflict between parents as a cause of problems in children - attention is concentrated on the symptoms themselves and the environmental responses that reinforce them - behavior therapy's basic premise is that behavior will change when contingencies of reinforcement are altered. - cognitive-behavioral therapists believe that dysfunctional attitudes about family roles and relationships are learned growing up in our families. - among the kinds of cognitive distortions that cognitive-behaviorists track are: arbitrary influence, selective abstraction, overgeneralization, magnification and minimization, personalization, dichotomous thinking, labeling and mislabeling, and mind reading

What is a Task Group?

Task groups are groups of individuals brought together to accomplish a specific action or produce a product - task groups may be educational planning meetings; committee meetings; treatment team meetings; student government meetings (MSWSO) or social movement meetings - social workers may be involved in the position of leading task groups during their careers Five areas that are often cited by the experts on task groups that can make or break task groups are the five C's; 1. Control 2. Conflict 3. Communication 4. Consensus 5. Cohesion

Cognitive-Behavioral Family Therapy: Theoretical Formulations

The basic premise of behavior therapy is that behavior is maintained by its consequences - behavioral problems are caused by dysfunctional patterns of reinforcement between parents and children, or between members of a couple - behavior will remain resistant to change until more rewarding consequences are introduced Thibaut and Kelley's theory of Social Exchange guided behavior therapists as they shifted their attention from individuals in isolation to family relationships Social Exchange Theory: States that people strive to maximize rewards and minimize costs in relationships - it provides a basis for understanding the reciprocity that develops in couples - in successful relationships, partners work to maximize mutual rewards and minimize costs, while in unsuccessful pairs, partners concentrate on minimizing costs, and have little expectation of rewards Behavioral Therapy: Tends to operate from a linear perspective in the treatment of children - for example, the parents' behavior causes the child's behavior, and the child's behavior causes family problems - this paradigm uses a dyadic unit of analysis rather than a triadic one - the focus is on changing interactions between two family members, typically parent (usually mom) and child, or spouse and spouse. Little attention is paid to the triadic nature of these relationships - how two people affect and are affected by others in the family Cognitive Therapy: Inspired by the work of Albert Ellis and Aaron Beck, emphasizes the need for attitude change to promote and maintain modifications in behavior - our interpretations of other people's behavior influences the ways in which we respond to them - cognitive techniques became more prominent as behavior therapists realized that the straight behavioral approach failed to address the complicating dynamics of couple and family interactions Normal Family Development: Problem-solving skills and the ability to resolve conflicts are the most clearly identified criteria for successful marriages - in healthy marriages, partners are able to speak openly and directly about conflicts, keep issues in perspective, and discuss specific behaviors that are of concern to them - each is willing and able to understand the other's viewpoint - behaviorists believe that good relationships are the product of learning effective coping behavior - the capacity for adaptability, flexibility, and change are also emphasized - family rules should be comprehensive and flexible, and social reinforcement dispensed equitably and frequently - positive control should be the primary mode of reinforcement, rather than punishment or coercion

Cognitive-Behavioral Family Therapy

The behavioral approach is based on social learning theory, according to which behavior is maintained by its consequences, and therefore can be modified by altering those consequences. - cognitive-behavioral approaches have expanded this formula to include the examination and restructuring of perceptions and attitudes. - so, while techniques of reinforcement are applied to target behaviors, families are also taught principles of behavior management along with methods for re-evaluating cognitive distortions and correcting misconceptions - behaviorists generally don't see whole families; instead they see those subsystems they consider central to the targeted behavior The greatest influence on behavioral family therapy came from operant conditioning, according to which the frequency of behavior can be increased by positive reinforcement or decreased by ignoring or the use of punishment - Skinner himself was the first to suggest that behavior problems could be resolved by adjusting the contingencies of reinforcement, and beginning in the 1960s behaviorists began experimenting with applications of operant conditioning to family problems; especially with children and couples - behavioral family therapy became increasingly popular in the 1970s - beginning in the mid 1980s, behaviorists began to rely more on cognitive strategies, to the point where today cognitive-behavior therapy is the most widely used behavioral approach to working with couples and families

Strategic Family Therapy: Positive Feedback Loop

The centerpiece of Strategic Family Therapy is the concept of "positive feedback loops" - - this is when the response to a family member's problematic behaviors then exacerbates the problem which leads to a vicious cycle Example: Jamal feels threatened by the arrival of his baby sister and at times has become "difficult" according to parents. His father thinks Jamal is being defiant and tries to get him to act his age by punishing him. The father's harshness only confirms Jamal's belief that his parents love his sister more than him, and he then acts even younger. Father, becomes more critical and punitive and Jamal feels alienated. - the response (negative) has the effect of amplifying the problem - what is needed here is for the father to reverse his solution - if he could comfort rather than criticize Jamal and actually help him to see that he isn't being replaced, than Jamal might feel calmer and reassured - the system is governed here, however, by unspoken rules that allow for only one interpretation of Jamal's behavior; disrespect. - for the father to change his solution, the rule must be revised

Family Life Cycle

The emotional and intellectual stages you pass through from childhood to your retirement years as a member of a family - in each stage, you face challenges in your family life that allow you to build or gain new skills - it encompasses the developmental stages that families pass through - Carter and McGoldrick (1988) identified six stages of family development, which are related to the comings and goings of family members over time (their model is based on the "so-called" middle class American family) 1. Unattached young couple 2. New couple 3. Family with young children 4. Family with adolescents 5. Family that is launching children 6. Family in later life To master these stages, families must successfully complete certain tasks - for example, the young adult who is unattached must differentiate from their family of origin and become a "self" before joining with another person to form a new family system - in all of the stages a family developmentally goes through, problems are most likely to appear when there is a disruption or dislocation in the family system, causing the family to become "stuck" and have difficulty moving through the transition to the next phase - in today's world, the ground rules have changed impacting the timing and sequence of events - variations also occur in the family life cycle due to culture

Psychoanalytic Family Therapy: Theoretical Formulations

The essence of psychoanalysis is the interpretation of... 1. Unconscious impulses and the defenses that oppose them 2. Childhood expectations of significant others that distort current relationships Object Relations Theory: Focuses on interpersonal relationships and their distortion - bridges the gap between classical psychoanalysis (the study of individuals and their drives) and family therapy (the study of social relationships) according to object relations theory, our identities are formed in relationships; past and present - we relate to people in the present based on early experiences with caregivers. these early experiences give rise to "internal objects," mental images of self, others, and self in relation to others - these internalized objects form the core of our selves, and in turn largely determine how we relate to others - the necessary and sufficient condition for successful completion of separation-individuation is reliable and loving support - good-enough mothering enables children to achieve a firm sense of identity and a lifelong capacity for mature object relations Kohut's Self-Psychology: Focuses on people's longing to be appreciated, and need to idealize and receive mirroring from their parents - a child raised by accepting and appreciative parents is secure, able to love, and able to stand alone as a center of initiative in adulthood - two qualities of parenting are deemed essential for the development of a secure and cohesive self 1. Empathy: Attentive parents convey a deep appreciation of how their children feel 2. Model for Idealization: The child internalizes a sense of strength from identifying with the apparently infinite power of the parents Depth Psychology: Refers to approaches to therapy that are open to the exploration of the subtle, unconscious, and transpersonal aspects of human experience - a depth approach may include therapeutic traditions that explores the unconscious and involves the study and exploration of dreams, complexes, and archetypes - depth psychology is non-pathologizing and strength affirming - from a psychoanalytic perspective, the fate of family development is largely determined by the early development of the individual personalities who make up a family - if the spouses are mature and healthy adults, then the family will be happy and harmonious Normal Family Development: Draws from object relations theory, attachment theory, and theories of the self - the outcome of good object relations in childhood is a secure and successfully differentiated personality - these characteristics endow a child with the capacity to delay gratification, tolerate frustration, and achieve competent ego functioning; he or she will have a solid sense of self and will be able to tolerate closeness with as well as separateness from others

Experiential Family Therapy

The experiential emphasis on emotional expression was a valuable counterweight to the cognitive and behavioral emphasis of the other schools of family therapy - experiential therapists drew evocative techniques and structured exercises from gestalt therapy, encounter groups, and psychodrama - linked the emotional impact of the individual and family interactions - the experiential branch of family therapy (which emphasizes immediate, here-and-now experience and emotional expression) was most popular when family therapy was young - today, such approaches as internal family systems therapy and emotionally focused couples therapy are revitalizing the experiential approach which seemed to fade in popularity in the 1980s The primary tenet is the notion of experiencing - experiencing is viewed as the primary vehicle towards achieving therapeutic change - EFT works from the inside out - uncovering honest emotions, hopes, and desires as well as fears and anxieties - less concern for the family as a whole - strengthening families by encouraging: 1. Individual self expression 2. The individual's emotional well being 3. Genuine family ties

Individual Psychotherapy

The focus in individual therapy is on the development of a one-to-one relationship with the therapist - this therapeutic relationship is of upmost importance There are many different types of therapy modalities/treatment orientations - in individual therapy, there is much emphasis on the creation of an accepting atmosphere along with the use of a variety of techniques/interventions for the purpose of symptom reduction and/or personal development - the individual is engaged in a self-reflective process on his or her emotions and behaviors Individual therapists, depending on their orientation, do believe in the role that families have played for their clients, however, they believing in working with the individual and the internalizations and intrapsychic dynamics that make up the client's personality

Psychoanalytic Family Therapy: Goals

The goal of psychoanalytic family therapy is intrapsychic personality change - ideally, family members are freed of unconscious restrictions so they can interact with one another as whole, healthy persons on the basis of current reality rather than unconscious images of the past - family members are helped to reintegrate split-off parts of themselves in order to become more fully integrated, which leads to improved relations with others - at times, psychoanalytic family therapists will opt for crisis resolution, with symptom reduction as the goal - here treatment is short-term, with the focus on supporting family members' defenses and clarifying communication, rather than analyzing defenses and uncovering repressed needs and impulses Bentovim and Kinston's 5-step strategy for developing a focal psychodynamic hypothesis: 1. How does the family interact around the symptom, and how does that interaction effect the symptom? 2. What is the function of the current symptom? 3. What disaster is feared by the family that keeps them from facing their conflicts more squarely? 4. How is the current situation linked to past trauma? 5. How would the therapist summarize the focal conflict in a short memorable statement?

Cognitive-Behavioral Family Therapy: Goals

The goals of behavioral family therapy are to increase the rate of rewarding interactions in family relationships, decrease use of coercion and aversive exchanges, and teach communication and problem-solving skills - therapy begins with a thorough assessment to determine the baseline frequency of problem behavior, following which specifically tailored strategies are designed to modify the contingencies of reinforcement maintaining that behavior Behavior change remains the primary focus, but more and more behaviorists are including a variety of cognitive strategies to help family members become aware of and modify problematic assumptions and attitudes - in addition to the widespread inclusion of cognitive strategies, behaviorists are becoming increasingly sophisticated about taking into account the systems dynamics in which problem behaviors are embedded

Therapists Training

Therapists need to be trained in each of these different types of therapy The different treatment modalities require different skills - while there are some basic qualities to the interventions, there are significant differences in how to intervene in these different modalities Someone trained in individual therapy only is typically not adequately prepared to do couples therapy or run a psychotherapy group - in contrast, couples and group therapists have usually begun their training by learning individual therapy

Transference & Countertransference

Transference: the unconscious redirection (projection) of the feelings a person has about their parents, as one example, on to the therapist - it usually concerns feelings from a primary relationship during childhood Countertransference: the redirection of a psychotherapist's feelings toward a client - more generally, as a therapist's emotional entanglement with a client

Classification of Groups

Treatment Groups: 1. Support 2. Educational 3. Growth 4. Therapy 5. Socialization 1. Support Groups: Help members cope with life stresses by revitalizing coping skills so they can more effectively adapt to life events/ - support groups help individuals who are coping with a situation or condition in their lives - for example, divorce, depression, cancer or other diseases - support groups teach patients coping techniques while offering emotional support and understanding - therapists use linking techniques to connect patients to each other and form support networks, and empathy techniques to establish a group mood that is supportive and understanding - patients attend support groups for extended periods of time, work through individual issues and learn new coping mechanisms 2. Educational Groups: Have the primary purpose of helping members learn about themselves and their society - role of the facilitator is to educate - targeted for the pre-contemplative and contemplative stages of change - provides information about recovery - structured with specific content 3. Growth Groups: Stress self-improvement, offering members opportunities to learn more skills and self awareness and make personal changes - these groups focus on promoting socio-emotional health rather than alleviating socio-emotional deficits - the basis of a growth group is some area of personal concern in which individuals wish to become more proficient - for example, interpersonal communication, sensitivity training or motivation - patients practice new skills or learn new social techniques - growth groups offer emotional and psychological support while providing information and instruction about how to change old habits and learn new ones 4. Therapy Groups: Help members change their behavior, cope with or ameliorate their personal problems or rehabilitate themselves after a social or health trauma - role of the facilitator is to monitor individual and group needs - early experience affects later experience - focuses on the NOW - interactions in a group setting - explores attachments The aim of this approach is to help members understand the effect their behaviour has on others and...how others' behaviour affects them...these groups place an emphasis on interpersonal interactions that occurs in the group (Flores, 1997) Interpersonal Learning: - The groups as a social microcosm (Yalom, 1995) 1. The importance of interpersonal relationships 2. The corrective emotional experience There are Three Primary Forces Operating: 1. Intrapsychic or individual dynamics, 2. Interpersonal dynamics/system and 3. Group as a whole Group therapy is used to guide clients through the process of gaining insight about themselves, others, and the world around them - through the group dynamic, - clients foster hope - examine core issues - develop their communication skills and - learn to engage in fun, healthy social experiences. - the group dynamic encourages honest feedback and facilitates bonding between individuals with shared experiences - clients weigh in on the issues of others in order to offer suggestions or provide outside perspectives, broadening the individual's understanding of the conflict 5. Socialization Groups: Facilitate transitions through developmental stages, from one role or environment to another, through improved interpersonal relationships or social skills How Effective is Group Therapy? Group therapy can be very effective, especially in certain situations - studies have shown that group therapy can be an effective treatment choice for depression and traumatic stress - an article published in the American Psychological Association's Monitor on Psychology suggests that group therapy also meets efficacy standards established by the Society of Clinical Psychology (Division 12 of the APA) for panic disorder, bipolar disorder, obsessive-compulsive disorder, social phobia and substance abuse The principal advantages of group therapy include: 1. Group therapy allows people to receive the support and encouragement of the other members of the group - people participating in the group can see that others are going through the same thing, which can help them feel less alone 2. Group members can serve as role models to other members of the group - by observing someone successfully coping with a problem, other members of the group can see that there is hope for recovery - as each person progresses, they can, in turn, serve as a role model and support figure for others - this can help foster feelings of success and accomplishment 3. Group members can serve as role models to other members of the group - by observing someone successfully coping with a problem, other members of the group can see that there is hope for recovery - as each person progresses, they can, in turn, serve as a role model and support figure for others - this can help foster feelings of success and accomplishment 4. Group therapy is often very affordable - instead of focusing on just one client at a time, the therapist can devote his or her time to a much larger group of people 5. Group therapy offers a safe haven - the setting allows people to practice behaviors and actions within the safety and security of the group 6. By working in a group, the therapist can see first-hand how each person responds to other people and behaves in social situations - using this information, the therapist can provide valuable feedback to each client

Experiential Family Therapy: Newer Forms

Two of the newer forms of experiential therapy, emotionally focused couples therapy and internal family systems therapy, are somewhat more systematic 1. Emotionally Focused Therapy: Couples therapist endeavors to help partners get past their reactivity toward each other and to get in touch with their hurts and longings for attachment - Sue Johnson, 1980's - draws on attachment theory and Carl Roger's person-centered therapy - bonding and attachment - used for couples and families - to address distress in intimate relationships - to help family members connect and improve emotional attachment - couples learn to interact in more loving, responsive, and emotionally connected ways - couples get stuck in patterns and cycles of negative interactions which make safe emotional connection and engagement impossible - the more one demands, the more the other withdraws... - more empathy leads to a new experience of each other and changes their interactions - increase attachment, sense of belonging among family members - access emotions underlying interaction patterns - all members are coached in identification and expression of attachment related emotions that are linked to conflict, acceptance, compassion towards emotions of other family members, and healthy positive expression of needs and desires - recommended for addressing major transitions such as children reaching adolescence - research on usefulness for eating disorders 1st Goal of Therapy: Building an Alliance - therapist creates a safe holding environment in order for them to open up to intense emotions - create a relationship with each person in the room, in which the therapist is warm, supportive, understanding, genuine, and empathic 3-phase, 9-step model - in these steps the therapist moves between helping uncover and express their emotional experience and helping them reorganize the patterns of their interactions Phase 1- Assess and Deescalate Phase • Step 1- Identify the conflict Jointly created by assessing goals and agendas of all individuals in the room • Step 2- Identify the cycle where conflict is expressed - identify the negative interactional attachment cycles that occur and the feeling that are experienced during these cycles and reflect back to family - interrupt and redirect conversation when individuals talk about things other than the interactional cycle of focus • Step 3- Access unacknowledged emotions - uncovering primary or underlying emotions is difficult, notice the language used - may seem dramatic but captures an intense, painful, powerful emotional experience (i.e. I feel like I'm drowning) - secondary emotions: anger and resentment are easier to show and talk about • Step 4- Reframe- victims of the cycle and now allies against it Steps 1-3 sometimes called the 3-P's Present context, Process patterns, and Primary affect Phase 2- Change Events Phase - creating corrective emotional experiences • Step 5- Promote identification of disowned needs - use of "I" statements to identify needs for self. • Step 6- Promote partner acceptance - priming other individuals to accept and maybe meet those needs - by staying engaged with their own emotional experience and being open to other's emotional experiences then are able to present their needs in a way that pulls the other towards them and maximizes possibility that they will respond • Step 7- Facilitate expression of needs and wants - restructuring interactions. - monitor the acceptance by others of the person expressing their emotional experiences - reframing difficulties in stating desires or accepting new expressions as their own vulnerabilities and fears arising from past experience of negative cycles - facilitate other's hearing, processing, and responding to the new shared experiences Phase 3- Consolidation of Change Phase • Step 8- New solutions Encouragement and support, highlighting the changes that have occurred - validate each family members movement toward change; give specifics - help other family members be open and responsive to those who are proactively making changes in the interactional cycle - continue observing new attachment experiences and questioning of feelings evoked by the new interactions. - teach and request that participants begin interrupting their own negative interactional cycles and practice techniques • Step 9- Consolidation - all members should be able to reflect on changes made, should be able to identify feelings evoked - termination Dancing the EFT Tango- Sue Johnson 5 Basic Moves of EFT that are repeated again and again as you move through the stages and steps of the model 1. Reflect present process 2. Explore slightly different deeper or new emotions 3. Set up/create enactments 4. Process the enactment (How it feels to tell partner..., How it feels to hear..) 5. Integrate, validate, reflect process "tie on a bow" 2. Internal Family Systems Therapy: Works by helping family members identify reactive "parts" of themselves and, using visual imagery, relax those parts so that their more genuine feelings can emerge

Yalom's Curative Factors of Group Therapy

Yalom (1995) defined therapeutic factors as "the actual mechanisms of effecting change in the patient" (p. xi). - he suggests that therapeutic change is a hugely complex process that occurs "through an intricate interplay of human factors" Yalom identified 11 factors that influence the processes of change and recovery among group therapy clients 1. Instillation of Hope: Gaith that the treatment mode can and will be effective 2. Universality: Demonstration that we are not alone in our misery or our problems 3. Imparting Information: Didactic instruction about mental health, mental illness, psychodynamics or whatever else might be the focal problem of the group - for example, Alanon, AA, learning about the disease process itself 4. Altruism: Opportunity to rise out of oneself and help somebody else; the feelings of usefulness 5. Corrective Recapitulation of Primary Family Group: Experiencing transference relationships growing out of primary family experiences providing the opportunity to relearn and clarify distortions 6. Development of Socializing Techniques: Social learning or development of interpersonal skills 7. Imitative Behavior: Taking on the manner of group members who function more adequately 8. Interpersonal Learning: Receiving feedback from others and experimenting with new ways of relating 9. Group Cohesiveness: A cohesive group is one in which all members feel a sense of belonging, acceptance, and validation 10. Catharsis: Opportunity for expression of strong affect 11. Existential Factors: Recognition of the basic features of existence through sharing with others - for example, ultimate aloneness, ultimate death, ultimate responsibility for your own actions Psychotherapy Groups The therapy group resembles a family in many ways - there may be parental/authority figures, peer and sibling figures - in a psychotherapy group strong emotions will be experienced with hopefully deeply personal revelations that may bring about deep intimacy and produce a whole range of emotions - often times, a therapy group is led by a male and female therapist to try and simulate the parental configuration - initially, members of a group will be on their "best" behavior - as time goes on, members will interact with the group leaders and group members in modes that are reminiscent of the way they once interacted (or still do) with family members and friends - one of the goals of group therapy is that not only early familial conflicts are relived, but that they are relived correctively - transference and insight play a central role in effective group work The Importance of Group Cohesiveness In Yalom's book, cohesiveness is broadly defined as the result of all the forces acting on all the members such that they remain in the group - another way of defining cohesiveness is the attractiveness of a group to its members - members of a cohesive group feel connected; feel warmth, a sense of belonging and comfort - they value the group, are valued, accepted and supported by the other group members Cohesiveness is not only a potent therapeutic factor but a precondition for other therapeutic factors to function at their best - as in individual therapy, conditions must be present where there is risk taking, catharsis, intra-personal and interpersonal explorations for the therapy to be healing and effective - in group therapy, it is the affecting sharing of one's inner world and then the acceptance by others which is so important - this acceptance challenges the client's beliefs that they may have about themselves...shame, unlovable etc. - "therapy groups generate a positive self reinforcing loop, trust, self-disclosure, empathy, acceptance, and trust" The importance of the here-and-now - it is the therapist's job to move the group into the here and now - the therapist will set the norms of interpersonal confrontation, of emotional expressivity, of self-monitoring of valuing the groups as an important source of information which helps to keep the focus on the here and now A group therapist is constantly thinking... - "how can I relate this to the group?" - "how can I make it come to life in the here and now?" - the therapist is invested in the illuminating the process Therapy group is a social microcosm and a re-enactment of the primary family - therapists should listen to their patients - clients should listen to and learn from one another - these groups further encourage exploration of emotional and interpersonal conflicts, confrontation about denial and harmful behaviors, and discussion about responsibilities and limitations - they add structure to chaotic lives and provide a safe environment in which to practice newly developed skills - other goals of group therapy include gaining inspiration through the recovery of others, self-identifying as a recovering addicting, and examining core values - groups can be as small as three or four people, but group therapy sessions often involve around seven to twelve individuals (although it is possible to have more participants) - the group typically meets once or twice each week for an hour or two - according to author Oded Manor in The Handbook of Psychotherapy, the minimum number of group therapy sessions is usually around six but a full year of sessions is more common - manor also notes that these meetings may either be open or closed - in open sessions, new participants are welcome to join at any time - in a closed group, only a core group of members are invited to participate Selection of clients for psychotherapy groups is critical and is more like a deselection process Examples of exclusion criteria Someone who seems they will be unable to participate in group tasks: - someone who exhibits poor insight into themselves - someone who refuses to examine themselves and his/her relationship with others - doesn't accept responsibility for life difficulties - someone who is in the midst of a life crisis

Experiential Family Therapy: Important Terms

• Alienation (from experience): Occurs when family members restrict their awareness of feelings • Conjoint Family Drawing: Family members are asked to draw their ideas about how their family is organized • Existential Encounter: Believed to be the essential healing force in the therapeutic process - the therapist establishes caring, person-to-person relationships with each family member while modeling openness, honesty, and spontaneity • Family Myths: Set of beliefs based on a distortion of historical reality and shared by all family members that help shape the rules governing family functioning • Family Sculpting: Experiential technique in which family members position themselves in a tableau that reveals significant aspects of their perceptions and feelings • Mystification: R.D. Laing's concept that many families distort their children's experience by denying or relabeling it • Parts: Term used in internal family systems therapy for a person's inner voices or sub-personalities • Self-Actualization: The process of developing and fulfilling one's innate, positive potentialities

Psychoanalytic Family Therapy: Important Terms

• Contextual Therapy: Boszormenyi-Nagy's model that includes relational ethics • Countertransference: Emotional reaction, often unconscious, on the part of the therapist to a patient • Delineations: Actions that express parents' image of their children - may be objective or distorted • Entitlement: Boszormenyi-Nagy's term for the merit a person accrues for behaving in an ethical manner toward others • False Self: Winnicott's term for a defensive facade that characterizes some people's dealings with others • Fixation: Partial arrest of attachment or mode of behavior at an early stage of development • Holding: Providing a safe psychological space in which clients can feel accepted - not judged or blamed • Identification: Not merely imitation but assimilation of traits of an admired other • Introjection: A primitive form of identification - taking in aspects of other people, which then become part of the self-image • Invisible Loyalties: Boszormenyi-Nagy's term for unconscious commitments that children take on to help their families • Mirroring: Expression of understanding and acceptance of another's feelings • Narcissism: Self regard - the exaggerated self-regard often equated with narcissism is pathological narcissism • Object Relations Theory: Psychoanalytic theory derived from Melanie Klein and developed by the British school which emphasizes relationships and attachment, rather than libidinal and aggressive drives, as the key issues of human concern. • Object Relations: Internalized images of self and others based on early parent-child interactions which govern a person's relationships with others • Projective Identification: A defense mechanism whereby unwanted aspects of the self are attributed to another person and that person is induced to behave in accordance with those attitudes • Regression: Return to a less mature level of functioning in the face of stress • Self-Object: Kohut's term for a person related to not as a separate individual, but as an extension of the self - an appreciative other who acts as a mirror • Separation/Individuation: process whereby an infant begins, at about two months, to draw apart from the symbiotic bond with mother and develop autonomous functioning • Transference: Psychoanalytic term for distorted emotional reactions to other people based on unresolved, early family relations • Unconscious: Psychoanalytic term for memories, feelings, and impulses of which a person is unaware • Working Through: Process by which insights are translated into new and more productive ways of behaving