Family Systems Theory
Pas de Deux (1)
Mom and son are on an island in the family... Help them strengthen boundaries and help them not feel like an island
Equifinality
No matter where one begins the ending will be the same. There are many different paths to the same outcome -The patterns of communication serve the function of maintaining the system in a steady state around a problem. The way family is interacting in the present provides the therapist with sufficient information to intervene effectively
4) Accordion
One family member is gone a lot of the time... (Military, truck drivers) -Problem is the emeshment with children of parent who stays home. Spouse who is gone becomes the villain or bad guy
Open and Closed Systems
Openness and closedness refer to the nature of the boundaries a family establishes around family members and between itself and other systems -The more input family members accept from other family systems, the more open it is as a system and vice versa
FST was also born out of the Child Guidance movement because the belief was that treating children would prevent the development of mental illness
Parental pathology CAUSED child pathology -Children needed to be protected therefore, treating them early helped prevent mental illness -Schizophrenic Mother: Dominering, aggressive, and insecure -Believed that pathological parenting was causing schizophrenia in children and into adulthood
Later Belief of the development of mental illness shifted to the idea that...?
Pathology was INHERENT in family relationships
Emotional Cutoffs (7)
People managing their unsolved emotional issues with parents/siblings/family members by reducing or completely cutting off emotional contact with them. -Cutoff can happen by physically leaving families or by staying in physical contact but avoiding sensitive or emotional issues in dialogue.
Sibiling Position (6)
People who grow up with same sibling position within their family share similar personality characteristics
First Order Cybernetics (FST Fundamental Concepts)
Position of therapist as an "observer"- still an outsider looking in to help lead family to change and become healthy
Second Order Cybernetics (FST Fundamental Concepts)
Position of therapist is "part of the system"- therapist is part of the process -This is what the therapist is trying to achieve
What does it mean to think systematically? List around 6 things. EX: Each individual is a member of a larger family...
--Explore how each person affects and is affected by the other -Shift to study of the observable manifestations of relationships --Explore how all behavior is relative to its context -Family is also a subsystem of a greater subsystem: Suprasystems --Explore how families are influenced by their context
The Ethical Dimension of Therapy
-Be aware of the ethical responsibilities of the psychology profession: --Refer to the American Psychological Association (APA) Code of Conduct --Refer to the National Association of Social Workers (NASW) Code of Ethics -Be aware of "red flags" signaling unethical practices such as: --Specialness, attraction, alterations in the therapeutic frame ---Violation of clinical norms and professional isolation (EX: Thinking ethics don't pertain to you...)
Early FST Influences: Child Guidance Movement
-Born out of creation of child labor laws, founded on growing belief that treating children was the best prevention for development of mental illness
Primary Objectives for First Interview
-Build alliance with the family. Listen and gather necessary information and formulate hypothesis about what is maintaining the problem
Major Concepts of SFT
-Family Structure- refers to the way a family is organized into subsystems whose interactions are regulated by interpersonal boundaries ---Subsystems ---Boundaries (Emotional walls) -Diffuse=Enmeshment (Dependent, can't do things on their own) -Rigid= Disengagement (Promotes Independence) -Strength based, expect family to have the strength to fix their own problems
Bowen: Normal Family Development
-Family members vary along a continuum of differentiation (low to high) -Unfinished business: People continue to react with childish sensitivity to parents- or anyone who "pushes" our emotional buttons -Optimal/Family Development occurs when: --all family members are relatively differentiated --anxiety is low --members are in good emotional contact with families of origin
Bowenian Theory of Change
-Find an intellectual/emotional balance: increasing one's ability to distinguish between thinking and feeling within the self and with others (lowering anxiety and identifying one's own role in interpersonal interactions) -Understanding and insight= vehicle for change -Learning to use the above described ability to direct one's life, love problems, and manage relationships -Distinguish between thoughts and feelings -Client actively pursues differentiation -Differentiation of Self is much like "wise mind" of DBT
Family Systems Theory
-Focus on the process of what's happening in the relationships (interactions and communication) (people are influenced by other people) -lens through which we seek to explore and understand human functioning -map we use to navigate and make sense of the world through human relationships, strengths, and struggles -new approach to understand human behavior within social context -Therapist in FST are able to see in circles rather than lines... Big picture thinking
Bowenian Prominent Therapy Techniques
-Genogram -Nonanxious presence of therapist --Minimizes emotionality of sessions -Detriangulating (for the "therapy triangle") --Encouraging personal responsibility -Process questions --What about your wife's criticism upsets you most? --What makes talking about finances so difficult? --How do you express your anger? -Supporting Differentiation -"Going Home" -Coaching -The I Position
Process- (FST Central Concepts)
-How does the family interact and communicate? -Verbal -Nonverbal -Context
SFT: Methods and Techniques (8)
-In-session Enactment -Joining and Accommodating -Highlighting and Modifying Interactions -Boundary-Making -Unbalancing -Challenging Family Assumptions -Reframing -Shaping Competence
SFT: Theory of Dysfunction
-Inflexible- Family structures with difficulty adjusting to maturational (life cycle) or situational challenges -Rigid or diffuse boundaries between subsystems
Undifferentiation in marriage results in:
-Marital conflict -Dysfunction in one spouse -Symptoms in one or more children -Well-differentitaed people are resilient and flexible and are able to maintain intimate relationships
SFT Assessment (Or Diagnosis)
-Organization of subsystems -Range of enmeshment or disengagement -Observation of system's flexibility and capacity for change -Family life cycle/developmental stages -Contextual issues- sources of support and/or stress in families ecology
Goals for Initial Phone Call
-Overview of problem and arrange for family to come in for consultation
Bowenian Therapy Goals
-Reducing anxiety levels by increasing differentiation and de-triangulating -Opening currently closed communication -Increasing self-understanding of each member -Developing healthy attachments throughout family system
Family Assessment: Things to Remember
-Remember that every case is unique -Listen carefully to the families account of the problem and ask detailed questions -Systemic (Relating to a system: pertaining to or affecting the body as a whole) Context, stage of family life cycle, family structure, and communication problems -Be sensitive to gender inequalities, cultural issues, and ethical issues
What are some ways to set boundaries in families that have unhealthy ones?
-Separate family system from outside -Define roles and responsibilities within family -Determine what is and is not acceptable -Amount of information "allowed" to flow from inside out, and from outside in --Inside out: How much do you discuss "family business" with others? --Outside in: Openness to others' perspectives -The system must constantly interact with its environment, and boundaries are the means by which that system both accepts useful information and screens out "unacceptable" information
Therapy for Marital Violence- Some ways to help in the therapy process
-Special treatment approaches are taken for patients of marital violence such as: --Separate couples, assign offender to anger management, refer partner to treatment like battered women's group Remember: Traditional couple therapy is dangerous and distinction between "common couple violence" and "patriarchal terrorism"
Therapy for Sexually Abused Children- Some ways to help in the therapy process
-Special treatment is given for sexually abused children like --Ensure the abuse does not recur, reduce long-term effect trauma, and family systems approach supports the family while still protecting the child
What does Homeostasis refer to? (FST Fundamental Concepts)
-State of equilibrium or tendency to reach equilibrium. Also, the tendency for families to sustain normal functioning/ patterns of interaction unless someone or something intervenes -the construct which describes a system's tendency toward stability or a steady state
Structure- (FST Central Concepts)
-Subsystems? (Parents, grandparents, siblings) -Who makes the rules? (Implicit & Explicit)- Who gets to decide? -What are the boundaries?
FST Fundamental concepts: Systems Theory
-The essential properties of an organism are properties of a whole- these properties arise out of the interactions among the parts -We pay attention to "sequences of interactions" (behavior) because we cannot "see" what is happening inside the minds of individuals
Restructuring (Major Concepts of SFT)
-Therapeutic Interventions
Bowenian approach to family therapy
-Therapist maintains a neutral & objective stance -Presence of entire family not required -Emphasis on relationships with extended family- encourages client to develop own relationship with each member
SFT: Theory of Change (6)
-Therapy is guided by assumption that families are competent and should be respected -Reorganization of family structure -Establishing strong parental subsystem -Creating clear but flexible boundaries between subsystems -Enabling more functional adaptive patterns toward change -Helping families find strengths and resources
Termination Goals
-When family has resolved presenting problems and they feel they can manage their lives without professional help -(It is useful to review what was learned with the family at this stage)
Some major things to be aware of in the Family Assessment...
Presenting Problem Understanding the referral route Identifying the systemic context Stage of the life cycle Family Structure Communication Drug and Alcohol Abuse Domestic violence and child abuse Extramarital Involvements Gender Issues Cultural Factors
What are 2 ways families maintain homeostasis? (FST Fundamental Concepts)
1) -Family rules govern the range of homeostasis within a family- maintain balance and "keep the peace" 2) -Families rules are acceptable range of behaviors that a family will tolerate
General Systems Theory- (Bertalanffy) Systems are more than the sum of their individual parts (4 terms)
1) -Open vs. Closed systems 2) -Equifinality 3) -Morphogenesis 4) -Morphostasis
SFT: Normal Family Development (3)
1) Accommodation 2) Creation of Boundaries 3) Transition Through Family Life Cycle -Ability to adjust though transitional life cycles is the primary task of SFT -Spousal/ Parental subsystem needs to be strong in order to adjust healthy through life cycles
SFT: Enactments (3) Observing and modifying the structure of the family transactions in the immediate context of the family
1) Counselor recognizes a problematic sequence 2) Counselor "directs" or observes an enactment 3) Counselor guides the family to modify the enactment -Stopping interaction and commenting on what went wrong -Coaching to "keep going" but giving suggestions
What are the 8 Major concepts of Brownian Therapy?
1) Differentiation of Self 2) Emotional Triangles 3) Nuclear Family Process 4) Family Projection Process 5) Multigenerational Transmission Process 6) Sibling Position 7) Emotional Cutoff 8) Societal Emotional Process
Stages of SFT in the actual session (4)
1) Entire family is present for initial and often subsequent sessions 2) Joining with family in a position of leadership-stance of therapist as active and involved 3) Explore/Assess underlying structure 4) Intervene to transform structure -(Therapy tends to be brief)
Palo Alto (The Big 3) (Early Influence on FST) and the topic they all covered
1) Gregory Bateson 2) Don Jackson 3) Jay Haley -All involved with Schizophrenia -Schizophrenia makes sense in context of pathological family communication
What are some Working Concepts of FST (9)?
1) Interpersonal Context: Influenced by other family members 2) Complementarity: Reciprocity (mutual exchange)- How family relates to other families 3) Triangles- can be destructive 4) Process/Content 5) Meaning/Function of a symptom 6) Resistance 7) Family Narratives- We create stories (We story our experiences) 8) Gender- Differences in power 9) Culture- Social constructivism
Nuclear Family Emotional System/Processes- Four basic relational patterns that determines where family problems develop (3)
1) Marital Conflict- (Spouses externalize marital anxiety into marital relationships) - focus on inadequacies of spouse and attempt to control 2) Dysfunction in one spouse (Spouse pressures other to think/act in certain ways: other spouse yields- one accommodates more) 3) Impairment of 1+ children (focused anxiety on child) 4) Emotional Distance (Distance from family members to reduce anxiety: becomes isolated)
Common Family Roles (9) EX: The Placator
1) The placator (to appease or pacify, especially by concessions or conciliatory gestures) 2) The Disagreeable One 3) The Helpful Child 4) The Counselor 5) The Rebel 6) The Successful Child/ Hero 7) The Breadwinner 8) The Nurturer 9)The Lost Child
Common ways families manage anxiety and attempt to stabilize relationships (3) (Bowenian)
1) Triangulation- pull in 3rd person 2) Create emotional distance (silence, disinterest, depression) 3) Create conflict (magnifying inadequacies of partner)
Family Shapes (9)
1)Pas de Deux 2) Three Generational 3) Shoe 4) Accordion 5) Fluctuating 6) Stepparent 7) Families with a ghost- Death of a family member. Loss of family member, family has a hard time adjusting to new roles from loss. -Hos to fill the gaps from loss of a family member 8) Out of control 9) Psychosomatic
Accommodation (Major Concepts of SFT)
Ability to adjust through transitional life cycles
Differentiation of Self and Undifferentiated (1)
Ability to recognize healthy dependance of others, while staying calm and clearheaded enough to have own thoughts and feelings (separate from others); not being emotionally reactive -Able to balance their thinking and feeling -UNDIFF: Have a hard time maintaining their identity, making up their minds, and swallowed by other persons personality
Emotional Fusion (Togetherness):
Anxious attachment/ emotional reactivity, manifesting as dependency or isolation --Well- differentiated people are resilient and flexible and are able to maintain intimate relationships
Transitions Through Life Cycle (Major Concepts of SFT)
Are the family members adjusting?
Middle Phase of Treatment Goals
Begin to step back a take less directive role in session while encouraging family to rely on their own resources and encourage family members to take amongst themselves
What can a Rigid Boundary be?
Can be to _____: closed off
What can a Diffuse Boundary be?
Can be too____: open to all
Parentified Child (Major Concepts of SFT)
Child who is in the parenting role
Major Differences and similarities between Small Group Dynamics & FST produced by John Bell and Rudolf Driekurs
Common Roles and Focus on Process vs. Content where what group therapy and FST have in common They differed in that Families have shared histories, defenses, and futures and Families have different dynamics of power, status, and control
What did Wynne (NIMH) have on the Early Influence on FST?
Communication deviance in families with schizophrenia
What is a Double Blind (Early Influence of FST) and the example of the double blind?
Conflict created when a person receives contradictory messages in an important relationship and cannot leave or defend themselves -EX: Mother hugs and pulls away from child + child pulling away from mother based on her action = Mom saying, "Whats the matter, don't you love me?"
Early Phase of Treatment Goals
Continue to refine therapist's hypothesis and begin work with family to resolve conflict
Family Projection Process (4)
Primary way parents transmit their emotional problems to their child; projection can impair a child or increase vulnerability to clinical problems Often looks like: 1) Parent refocuses on a child out of fear that something is wrong with the child 2) Parent interprets child's behavior as confirming her fear 3) Parent treats child as if something is really wrong with them
Morphostasis
Describes the system-enhancing behavior that allows for growth, creativity, innovation, and change. It also says, change in the context of stability is required in order for the system to be able both to change and to maintain itself.
Strengths and Resources (Major Concepts of SFT)
Do families have these?
Launching children and moving on (Life Cycle) 5
Emotional Process of Transition: Key Principles: -Accepting a multitude of exits from and entries into family system Second Order Changes in Family Status Required to Proceed Developmentally a) Renegotiation of marital system as dyad b) Development of adult-to-adult relationships c) Realignment of relationships to include in-laws and grandchildren d) Dealing with disabilities and death of parents (grandparents)
Leaving Home; Single young adults (Life Cycle) 1
Emotional Process of Transition: Key Principles: -Accepting emotional and financial responsibility for self. Second Order Changes in Family Status Required to Proceed Developmentally a) Differentiation of self in relation to family of origin b) Development of intimate peer relationships c) Establishment of self in respect to work and financial independence
Families with young children (Life Cycle) 3
Emotional Process of Transition: Key Principles: -Accepting new members into system Second Order Changes in Family Status Required to Proceed Developmentally a) Adjusting marital system to make space for children b) Joining in childrearing, financial and household tasks c) Realignment of relationships with extended family to include parenting and grand parenting roles
Families in later life (Life Cycles) 6
Emotional Process of Transition: Key Principles: -Accepting the shifting generational roles Second Order Changes in Family Status Required to Proceed Developmentally a) Maintaining own and/or couple functioning and interests in face of physiological decline: exploration of new familial and social role options b) Support for more central role of middle generation c) Making room in the system for the wisdom and experience of the elderly, supporting the older generation without over functioning for them d) Dealing with loss of spouse, siblings, and other peers and preparation for death
The Joining of families through marriage: the new couple (Life Cycle) 2
Emotional Process of Transition: Key Principles: -Commitment to new system Second Order Changes in Family Status Required to Proceed Developmentally -a) Formation of marital system b) Realignment of relationships with extended families and friends to include spouse
Families with adolescents (Life Cycle) 4
Emotional Process of Transition: Key Principles: -Increasing flexibility of family boundaries to permit children's independence and grandparents' frailties Second Order Changes in Family Status Required to Proceed Developmentally a) Shifting of parent-child relationships to permit adolescents to move into and out of system b) Refocus on midlife marital and career issues c) Beginning shift toward caring for older generation
Boundary
Emotional or physical barrier that protects and/or enhances the integrity of self, others, family, etc. -Family system constantly interacts with its environment. ______ help the family system to accept "useful" information and screens out "unacceptable information. -______also distinguish between the individuals and subsystems within a family (parent dyad, sibling system.)
2) Three Generational
Extended family, single-parent family, grandparents -Problem in the hierarchy of the family system
What is Pseudomutality? (NIMH Group and Wynne)
Facade (Front) of family harmony and togetherness that masks conflict and blocks true intimacy
5) Fluctuating
Families who move around a lot. How do family members respond to change and adjustment? -Offer support, make known the degrees of change
9) Psychosomatic
Family member who is always sick...
Early Influence of Family Systems- John Bell and Rudolf Driekurs -What type of therapy did they apply to family systems?
First major theorist to apply group theory to family systems therapy
Open System
Flexible boundaries: open to change
What did Lidz (Yale) have on the early Influence on FST?
Found patterns of instability and conflict in these families with profound negative impact on child development
Anxiety in regards to Bowenian Therapy
Highly "motivating" force that directs both individual and family relationships and interpersonal behavior in Bowenian therapy
Multigenerational Transmission Process (5)
How small differences in levels of differentiation between parents and children and between members of sibling group lead, over multiple generations, to marked differences in differentiation between members of multigenerational family -Learning occurs through conscious, explicit teaching and through implicit, unconscious modeling -Transmitted info within relationships contributes to each individual's development of "self".
Morphogenesis
In order to be able to remain stable, a system must be able to change as appropriate
Managed Care
Increased role of managed care with mental health providers -Which patients can you see -Which treatment apply -What can you charge -How many sessions you can offer It's a good idea to -Start your career in a supervised agency -Market your skills -Maintain a positive attitude
Negative Feedback
Indicates that a system is straying off the mark and that corrections are needed to get it back on course. It signals the system to restore status quo Reduces deviation- chance for thing to be different is reduced -______ is telling the system what to get back to order/normal (Refer to thermostate)
Therapy shifted away from linear thinking (Cause & Effect) and instead shift toward Circular Causality
Linear thinking- A=B -"I treat you like a child (B) because you behave like a child (A)" -"I behave like a child (B) because you treat me like a child (A)"
Structural Family Therapy: Origins of the SFT Model
Major Theorist: Salvador Minuchin from Argentina- Popularized the term boundary - Worked with troubled youth and families -Worked with impoverished, multi problem families, and ethic groups. -Trained in child psychology -SFT addressed transitions between developmental stages is one of the highlights of SFT
Closed System
Rigid boundaries: averse to change
Detouring (Major Concepts of SFT)
Scapegoating the child Overprotecting the child from another family member
What did social workers influences have on FST?
Social work helpers can be given a lot of credit in bringing about FST
What is Pseudohostility? (NIMH Group and Wynne)
Superficial bickering that makes pathological alignments and splits in families; blurs intimacy and/or deeper hostility
Societal Emotional Process (8)
The emotional system that governs behavior on a society level, promotes both progressive and regressive periods in a society, cultural forces are important in how society functions -Adaptive and maladaptive patterns of managing anxiety in families are shaped and also impacted by cultural patterns
Cybernetics: Feedback Loop (FST Fundamental Concepts)
The study of feedback mechanisms in self-regulating systems. The brainchild of MIT mathematician Norbert Wiener (1948), who developed what was to become the first model of family dynamics
Some defining concepts of Bowenian Therapy
Theory centers around 2 counterbalancing concepts: Togetherness and Individuality
Positive Feedback
This is information that reinforces the direction a system is taking. Amplifies deviation- chance for things to be different is amplified -girl gets a nose ring (Refer to thermostate)
Emotional Triangles (2)
Three person relationship system -Driving forces is anxiety -Addiction, TV, Games, etc.
Coalitions/Alliances (Cross-Generational Coalition)(Major Concepts of SFT)
Two family members against the more powerful family member -EX: Mom & Son vs Dad
Emotional Cutoff (Bowenian Therapy)
Unbalance in direction of individuality
Fusion (Bowenian Therapy)
Unbalance in direction of togetherness
3) Shoe
Very large family. -Look for problems with authority... who is in authority.
Social Constructivism (FST Fundamental Concepts)
We learn and internalize the norms, values, etc, of our sociocultural context (language, metaphors, and ways of thinking) - We put an interpretation on reality based on our own constructs -What we have learned is from society -This stems out of Post-Modernism which says there is no absolute truth= Each of us see reality from a different perspective
Rigid, Normal and Diffuse
What does __________ mean? what does -------- mean? what does ......... mean?
Constructivism (FST Fundament Concepts)
While a real reality somewhere out there is not denied by such a stance the possibility of a "true" representation of that reality is denied... -The meaning of the reality in which we live -Reality is constructed though a persons on personal lens -This stems out of Post-Modernism which says there is no absolute truth= Each of us see reality from a different perspective
Family Structure (Major Concepts of SFT)
refers to the way a family is organized into subsystems whose interactions are regulated by interpersonal boundaries -Subsystems (Marital, Parental, Child/Sibling) -Boundaries (Emotional walls) -Diffuse=Enmeshment (Dependent, can't do things on their own) -Rigid= Disengagement (Promotes Independence)