Systems Theory and Family Therapy

Systemic Assessment Cont...

Research is showing the multiple family configurations can be functional... It is less about the actual formation of the family MAIN POINT: The functionality of the family is more about communication, family processes, and relationship quality. Do not be quick to assume that the form of a family is an indicator of its functioning (like don't assume a family with step-children/parents is going to be bad)

Family rituals (Milan Systemic Model)

May have family do a ritual that's different from symptoms (eg., quality time) Thanking symptom carrier for having symptom

Emotional Cutoff (Bowenian)

May occur by moving away, isolation, or emotional avoidance This can stem from being emotionally fused in relationships Function of distancing is to maintain homeostasis or equilibrium Common for fusion and cutoff to both exist in the same extended family This is a "flight from an unresolved emotional attachment" per Bowen Emotional cutoff can be either physical or emotional It takes 2 people to maintain the cutoff

The Therapeutic Relationship (Narrative Therapy)

Meeting the Person Apart from the Problem Separating People from Problems: The Problem is the Problem Optimism and Hope Co-author/Co-editor Investigative Reporter --Developing an expose or account of the problem

MRI Brief Therapy (Strategic Therapy)

Mental Research Institute Started by Don Jackson Virginia Satir Jay Haley John Weakland Paul Watzlawick Brief Therapy Project Richard Fisch Arthur Bodin Jay Haley John Weakland Paul Watzlawick

Divorce Busting (Solution Based Therapy)

Michelle Weiner-Davis Strengths-focused Present Focused Small changes lead to larger changes Idea that it only takes 1 person to change Specific goals Identifying patters/behaviors that work and increasing them Decreasing ineffective patterns and behaviors Predicting good days

Solution Based Contributors

Milton Erickson Hypnosis Brief Strength-based focused Bill O'Hanlon and Steve de Shazer's Solution-Focused Steve de Shazer and Insoo Kim Berg Solution-Focused Brief Therapy Milwaukee Brief Family Therapy Center Scott Miller, Barry Duncan and Mark Hubble, Yvonne Dolan, and Linda Metcalf Solution-Oriented Therapy Bill O'Hanlon Michelle Weiner-Davis Collaborative, Strength-Based Therapy Matthew Selekman

Structural Therapy

Minuchin

Second order change

Minuchin A change in the system itself More lasting and concrete Eg: I stopped berating you in public because I understand how it impacts you

First order change

Minuchin Superficial change Eg: I bought you flowers because I hurt your feelings

Collaborative and Narrative Therapies

Most recently developed Similarities: --Social constructionist foundations --Language based --Possibility focus --Identity construction Differences: --Stance of the therapist --The role of interventions --Emphasis on political issues

More Systemic Assessment

Multidimensional Contextual (are they coming to you in the midst of a tragedy, etc.) Process/content Sequential/priority (What is top priority? example: getting a daughter to come out of her room) Responsive to family needs

Transgenerational Therapy

Murray Bowen Can be used with couples, families, and/or individuals This theory is heavy on theory rather than intervention ... and is frequently intertwined with other models Differentiation of self Triangulation Multigenerational Transmission Process Emotional Cutoff Nuclear Family Emotional System Family Projection Process Sibling Position Societal Emotional Process

Myths of Solution-based Therapy

Myth #1: They propose solutions to clients (which amounts to advice giving) --Client identifies solutions, therapists assist client in identifying solutions and they identify exceptions to the problem (when during your life do you not talk about the problem?), describe what is already working, and identify client resources Myth #2 They never talk about the problem --They spend less time talking about the problem --They take their lead from the client --Hallmark techniques, such as exception questions require they talk about the problem

Myths of Solution-based Therapy

Myth #3: They never talk about the past --When they talk about the past, they focus on strengths --Talking about the past is important - it helps to identify what has worked and what has not Myth #4: Emotions are not discussed in therapy --They do not view the expression of emotions as curative in and of itself (as with humanistic therapies) --Instead, emotions are used as clues for works and where they want to go

Goal Setting (Narrative Therapy)

Narrative Therapy does not include a set of predefined goals - goal setting is unique to each client Increase the clients sense of agency - the sense that they influence the direction of their lives Therapist allows the client to take the lead in defining the preferred realities and helps the client reflect on where the idea came from and the effects it will have

Examples of the process of cutoff:

Not communicating due to distance Avoiding communicating bad news Increased conflict prior to separation (launching) Being different from parent in order to increase emotional distance Choosing not to acknowledge birthdays, anniversaries, or family events No eye contact or verbal communication Not using individual's name Not initiating contact (but responding to it) Not initiating contact or responding to it

Holistic assessment:

Obtain perspective of each family member Who is identified as a family member? Not always a "blood" relative Explain that family does not have to mean "household" Examples: nanny, coach, college student Genogram can be a good assessment tool Family time lines can help identify important events and/or symptom presentation Include previous family subsystems (divorce, dating, remarriage) Anticipated future changes Especially consider changes in the family household

Areas to consider in your assessment:

Organization Patterns of the family Flexibility Is the family dependable? How does it respond to change? Rigid interactions? Connectedness between members (health is usually a midway point between enmeshed and disengaged) Boundaries Trust, respect Leadership forgiveness Social and economic resources (job changes can change the family system) Extended family Community networks

Family Projection Process

Parents transmit/project anxiety onto one of the children Parents present with a calm marriage; over-concerned and concentrated on child (symptom carrier) Family may bring child in for therapy when marital therapy is actually needed Experiential: Brainstorm on ways you may assess for this and then bring it up to the parents

Overview of Strategic Therapy

People are always communicating You cannot NOT communicate!! Process and content are always present Consider the context of the communication Family rules play a role Rules maintain homeostasis Circular Causality Feedback loop always in motion Main focus of this model (all 3)

Working Concepts

People are products of their context - specifically the family but can be applicable in other contexts There is complementarity in relationships: behaviors are linked together, patterns occur, we are influenced by others Linear causality versus circular causality - Linear looks at finding a root of a behavior versus a repeating cycle Cause and effect versus cycles Process versus content How people talk versus what they talk about Triangles Means to alleviate anxiety

Whitaker Assessing Structural Organization

Permeable boundaries with the families --Clear boundaries with larger systems --Role flexibility- ex: Mom wouldn't always have to be happy around the kids --Flexible alliances and coalitions --Generation gap --Gender-role flexibility: Do only the women cook? --Transgenerational mandates --"Ghosts"- who is present in the family but no longer living; the influence of someone lasts through generations

Circumplex Model: Closeness

"Balanced couples and families tend to be able to balance their separateness (I) versus their togetherness (We)." Couple and family closeness is measured by: Separateness/togetherness Closeness Loyalty Independence/dependence

Circumplex Model: Flexibility

"Balanced couples and families tend to be able to balance their stability versus change." Couple and family flexibility is measured by: - stability versus change - leadership - roles - discipline

Froma Walsh: Practical Principles

"No single thread distinguishes well-functioning from dysfunctional families, as pioneering studies have found." "When clinical formulations reduce the richness of family interactions to simplistic labels such as 'an enmeshed family', an alcoholic family', 'a codependent family', they both stereotype and pathologize families." -systemic therapy steers away from labeling people; labels keep us from seeing people as complex "Instead, mental health professionals must attend to the many strands that are intertwined in family functioning, and need to assess strengths and vulnerabilities on multiple system dimensions.

Whitaker Interventions

--Creating confusion and disorganization --Here-and-Now experiencing: "So what's it like to see your parents fight like they do?" --Redefining and expanding symptoms --Spontaneity, play and "Craziness" --Separating interpersonal from personal distress --Affective confrontation of rigid patterns and roles --Augmenting despair and amplifying deviation (he wanted people to despair on the way to change; he wanted a breaking point) --Absurd fantasy alternatives (maybe you should move to Africa so your kids won't fight over the car anymore) --Reinforce parental hierarchy --Sharing stories, free associations, and metaphors

Interventions (Narrative Therapy)

--Externalizing: Separating the Problem from the Person --Metaphors --Relative Influence Questioning: Mapping Influence of the Problem and Persons --Externalizing Conversations: The Statement of Position Map --Externalizing Questions --Problem Deconstruction: Deconstructive Listening and Questions --Mapping in Landscapes of Action and Identity/Consciousness --Intentional vs. Internal State Questions --Scaffolding Conversations --Permission Questions --Situating Comments --Narrative Reflecting Team Practices --Re-Membering Conversations --Leagues --Definitional Ceremony --Letters and Certificates

Emotionally Focused Therapy

--One of the most thoroughly researched approaches in the field, an empirically validated treatment for couples --Sue Johnson & Les Greenberg developed the model using a combination of ----Attachment theory ----Experiential theory ----System theory

Satir's Interventions

--Self of the therapist (letting the client know they affect you as a person/therapist as well) --Facilitate emotional expression --Communication enhancement: Coaching, Role Play, and Enactment --Sculpting or Spatial Metaphor --Softening family rules (decreasing family rules) --Touch -Virginia Satir Video

Whitaker's Battle for Initiative

-You should not be working harder than the client Refers to who has the most investment and initiative to pursue change and should be won by the client If the therapist has more initiative towards change, clients feel as if they are being "dragged" or "forced" Greater the clients motivation, the more the process flows smoothly

Intervention (MIlan Systemic Model)

Presession- involves family and clinicians Session Intersession- therapists talk to the observing team Intervention Postsession All in one session

The Clinical Interview (Bowenian)

-getting to know the individual and the family he/she comes from Used to obtain each individual's view of problem Therapist begins to develop FOO context/treatment frame as this will guide treatment Each individual's view of the problem is important as it frames the emotional needs and problem definition - this is used to shape interventions Important to obtain time frame of problems Looking for distribution of power Distribution of power can be observed in decision-making, financial issues, parenting Include affective assessment: how does family relate? Is there physical touch? Look for nonverbal and verbal expression of emotion Consider past needs/wishes that have been met or unmet and how they are currently impacting the family

Joining

-the process of connecting with those in your office in a way that gives you permission to call them on things. Make an attempt to connect with each individual on some level Your goal is to establish a safe environment for the family and the individuals Part of this is your empathy, therapeutic stance Another part is your curiosity Getting the perspective of each family member

EFT: Three primary therapeutic tasks

1. Creation & Maintenance of Alliance 2. Assessing & Formulating Emotion 3. Restructuring Interactions -----Three stages with nine steps Stage 1: De-escalation of Negative Cycles (What are they always fighting about) Stage 2: Change Interactional Patterns Stage 3: Consolidation and Integration

McCubbin: Ten general resiliency factors - both protective and recovery

1. Family problem solving and communication 2. Equality 3. Spirituality 4. Flexibility 5. Truthfulness (truth from family as well as agencies, doctors, etc.) 6. Hope (can things be better in the future?) 7. Family Hardiness 8. Family time and routines 9. Social support 10. Health

Three main phases of structural therapy (Structural Therapy)

1. Join The family accommodate to their style (build an alliance)- finding ways to join/align with people; establishing a safe place 2. Map The family structure, boundaries and hierarchy (evaluate and assess) 3. Intervene To transform the structure to diminish symptoms (address problems you identified in the assessment)

Global Assessment of Relational Functioning: Rating Scale

21-40 Relational unit is obviously and seriously dysfunctional; forms and time periods of relating are rare 1-20 Relational unit has become too dysfunctional to retain continuity of contact and attachment

Resilience: Froma Walsh

3 major areas of resilience Belief Systems Organizational Patterns Communication and Problem Solving Goals of the resilience perspective Decrease family risk factors Reduce negative chain reactions that heighten risk for sustained impact and further crisis Strengthen protective family processes and reduce vulnerabilities Bolster family and individual pride through successful problem mastery -Families that don't have resilience usually get stuck in the system.

Nuclear Family Emotional System

4 basic relationship patterns that can lead to problems within the family system Present in multiple family structures (not just the nuclear family) Family tension arises when external or internal stressors occur: tension appears in the form of anxiety within one of the patterns below: Marital conflict Dysfunction in one spouse Impairment of one or more children Emotional distance (fusion - little overt conflict) The anxiety within one of these four relationship subcategories may be what brings the family or marital dyad into therapy Consider... where does the anxiety present within this family? Case examples: Danny (22yo male from a successful family) Luke (18yo male at USN) The perfect family you may never see!

Global Assessment of Relational Functioning: Rating Scale

81-100 Relational unit is functioning satisfactorily from self report of participants and reports of observers 61-80 functioning of relational unit is somewhat unsatisfactory. Over a period of time, many but not all difficulties are resolved without complaints 41-60 Relational unit has occasional times of satisfying and competent functioning together, but clearly dysfunctional, unsatisfying relationships tend to predominate

Strategic Therapy

A broad category stemming from the communications model MRI Brief Therapy Haley & Madanes' Strategic Milan Systemic General concepts guide the theory, but interventions and therapist presentation may look different

Sibling Position

A concept not as commonly considered Bowen believed that sibling position within FOO played out in marital relationship Also contributed to family projection process: the child with anxiety projected onto them was oftentimes infantilized

Whitaker "Therapy of the absurd"

Absurdity is used to perturb the system Sometimes means speaking a truth Usually involves playing with otherwise "serious matters" -Trying to upset the system; sometimes playing around with serious matters

Leaving home: single young adults

Accepting emotional & financial responsibility for self Changes Required: Differentiation of self Develop intimate relationships Establish self in work & financial independence

Families with young children

Accepting new members into system Changes Required: Adjusting marriage to make space for kids Joining in new tasks Change in relationships: parenting and grandparenting

Launching children and moving on

Accepting numerous exits and entries into system Changes Required: Renegotiation of marriage Renegotiation of parent/child relationship Including in-laws and grandchildren Dealing with grandparents

Families in later life

Accepting the shifting generational roles Changes Required: Maintaining marriage Focus on middle generation Supporting older generation Dealing with loss

Invariant prescription (Milan Systemic Model)

Asking parents to have mysterious communication Inform the kids that a secret exists Continues until symptoms stop -reestablishes the parental hierarchy; could really change a child that is bossing the parents. -then the therapist could create a session with the child about what they think/fear the assignment is about

Satir's Case Conceptualization/Assessment

Assessment of Family Functioning includes: --Role of the symptom in the system --Family dynamics --Family roles ----------The martyr -----------The victim -----------The rescuer -----------The good/bad child/parent --Family life fact chronology (TIMELINE- client might just come up with factual things that happened, then in therapy you can explore the emotional components of these events) --Survival triad ------------Quality of relationship between child, mother, father Assessment of Individual Functioning includes: Communication Stances Self worth / self esteem Mind / body connection

Whitaker Case Conceptualization/Assessment

Authentic Encounters/Affective System --Focus is primarily on the family's emotional system rather than behavioral interactions Trial of Labor --Observing family response to therapist's interventions and interactions Competency Focus --Assessment involves emphasis on strengths, competencies, and resources for change Symptom Development --Symptoms develop when dysfunctional structures and processes persist over time; symptoms get worse over time

Whitaker's Therapeutic Relationship

Authentic use of self Personal integrity Therapist responsibility Being responsive TO the family without being responsible FOR them Stimulating mutual growth Co-therapist

Reflecting Teams and Reflecting Process (Collaborative Therapy)

Based on the practice where a small team of therapist would observe the therapist talking with families behind a one-way mirror, Tom Anderson and colleagues developed the idea of having the families listen to the team's conversation behind the mirror The idea is to develop multiple, contradictory perspectives in order that new meanings will be developed with clients

Whitaker's Battle for Structure

Battle for Structure Refers to setting the boundaries and limits for therapy and should be won by the therapist Specifically refers to: Ensuring necessary people attend therapy That therapy occurs frequently enough for progress Session content /process will produce change

Outside of the Therapy Room (Collaborative Therapy)

Because Collaborative Therapy is more a way of talking and being in the world, the process has been applied to numerous other contexts including: --Education and Pedagogy My article!! --Research --Business Consultation

Virginia Satir Growth Model

Began career in family therapy at the Mental Research Institute (MRI) Developed her own ideas broadly described as fusing humanistic values into a systemic approach-- aka: she added emotion to the therapeutic approach One of the first therapists to work with entire families Focus on individual growth and improving family interactions

The Therapeutic Relationship (Solution Based Therapy)

Beginner's Mind Involves listening to a clients story as if you are listening for the first time not filling in blanks with personal or professional knowledge Echoing client's key words Using client language often makes the problem more "solvable" and engenders greater hope Dual track thinking Conceptualizing client's words as well as your own reactions (Mastering therapy is making these two things work at the same time; whatever you're thinking and whatever you're hearing that are both going on at the same time)

Metaphor (Haley and Madanes)

Behaviors are frequently metaphors within the family Relationships may also replicate others

Areas to consider in your assessment:

Belief systems of the family -Shared or different- does everyone share that belief system? -Not just spiritual beliefs -Beliefs of change -Beliefs of ability to handle crises -Beliefs of strengths of the family and/or individuals -Family themes Achievement Money Status Athleticism Legacy

Solution Focused Therapy

Best known strength-based therapies Positive, active approach --Help clients move toward desired outcomes. There are two strands of practice which share many similarities --Solution Focused Brief Therapy --Solution-Oriented Therapy

Solution-Based Therapies: Overview

Brief therapy approaches influenced by Mental Research Institute (MRI) Milton Erickson's brief therapy and trance work Strength-based Popular with clients, insurance companies and mental health agencies Solution-focused Therapists spend a minimum of time talking about the problems Instead focus on moving clients towards solutions

Role of the Therapist

Build strong therapeutic alliance Looking at things from inside the system and creating safety to explore topics "Partiality replaces neutrality." Each individual knows the therapist is neutral TG therapist is transparent: using self but remaining separate/differentiated. Participant observer Self-disclosure helps family understand that the therapist is real and has also experienced challenges Disclosed material is resolved material so counter-transference does not occur

Types of Genograms

Can do genograms to focus on Mental health Spirituality Messages Physical health Relationships Genogram as intervention Increase awareness Finding patterns Psycho-education

Systemic Assessment

Can occur with individuals, couples, or families Does not focus solely on individuals- there's always a bigger story going on Focus on relationships- dynamics that affect each person Considers dynamics -within the family -Relationships -Interactions -outside of the family -Church, Extended Family, Neighborhood, School, etc. How do these dynamics impact: Individuals within the family The family as a whole

The Therapeutic Relationship Continued... (Solution Based Therapy)

Carl Rogers with a Twist: Channeling Language --Reflections of feeling delimit the difficult feeling, behavior or thought by reflecting on a time, context, or relational limit -Past tense rather than chronic state or characteristic -Partial rather than global -Perception rather than unchangeable truth Optimism and Hope --Solution-based therapists assume that change is inevitable and that improvement - in some form - is always possible

Basic Techniques of Family Therapy

Case Conceptualization Life Cycle Interaction Patterns Cultural Factors (even the culture of the family) Ethical Concerns (family secrets) (How am I ethically obligated to handle certain information?)

Interventions for Specific Problems (Narrative Therapy)

Children --Externalization works well with children - particularly the Externalizing Process which adapts well to play and art therapies --Acting out unique outcomes & preferred narratives often accelerates their adaptation of new behaviors Domestic Violence --Jenkins (1990) has developed a Nine-Step Model for working with men who batter which requires the client to take full responsibility for the violence and ending it

#3 Communication and Problem Solving (Resilience)

Clarity in a crisis, emotional expression Clarity Clear and consistent messages (verbal and nonverbal) Clarify ambiguity - speak the truth (say what you mean, do what you mean) Open Emotional Expression Emotions are accepted Empathy, humor Responsibility for personal emotions Little blaming Collaborative Problem Solving Brainstorming (coming up with a plan to attack/defend against the system)(example of prof's grandmother preparing to die and the family talking about it) -Shared decision making, negotiation, fairness -Conflict resolution -Create a concrete plan to solve the problem -Prevention of problems

Goal Setting (Structural Therapy)

Clear boundaries between all subsystems allowing connectedness & differentiation within cultural contexts Clear distinction between the marital/couple (as LOVERS) subsystem & parental subsystem (as PARENTS) Effective parental hierarchy Family structure promotes develop and growth

Not-Knowing and Knowing With (Collaborative Learning)

Collaborative therapists avoid "pre-knowing" also called assuming; just because a counselor works for 40 years doesn't mean they know how the client feels in their situation Based on a social constructionist epistemology, clients with apparently similar experiences, such as "psychosis," "mania," or "sexual abuse," have unique understandings of their situations Therapists view the clients knowledge as equally valid with their own

Overview of Collaborative Therapy

Collaborative therapists do not have set stages of therapy or an outline for how to conduct a session Guiding principle: facilitate generative, two-way dialogical conversations Key is to avoid monologues which lead to a therapeutic impasse If this happens, the conversation is gently shifted back to a dialogical exchange of ideas

Marriage: the new couple

Commitment to new system Changes Required: Formulation of marital system Realignment of relationships with extended family and peer group

Areas to consider in your assessment:

Communication Processes of the family Clarity of communication Messages are not ambiguous Expectations are clear Open emotional expression Emotional reciprocity Individuals allowed to have emotions that differ from others Collaborative problem solving Shared decision making; brainstorming Prevention of problems Conflict resolution

Satir's Contributions to the Field

Communication Stances: effective means of conceptualizing communication as each stance recognizes or minimizes three realities: self, other, context --Congruent: Acknowledge self, other, context --Placator: Acknowledge other, context; not self (often a people pleaser in a family) --Blamer: Acknowledge self, context; not other (Victim mentality that blames others) --Super-reasonable: Acknowledge context, not self or other (someone very in their head; often seen as unrelatable) --Irrelevant: Tries to avoid acknowledging any (the avoider, the clown of the family)

Homeostasis

Concept of homeostasis was one of the first concepts that guided family therapy The idea that families tend to resist change in order to maintain a steady state. Balance is maintained through homeostasis. Other approaches may call this "resistance" Family therapists believe this is what keeps individuals and families stuck in cycles and/or behaviors -Someone always needs to maintain one of the roles to keep Homeostasis going

The Therapeutic Relationship (Collaboration Therapy)

Conversational Partners: "Withness" Curiosity: The Art of Not Knowing Client vs. Therapist Expertise Everyday, Ordinary Language: A Democratic Relationship- The therapist does not talk like a therapist Inner and Outer Talk (The therapist shares from his/her perspective)

Interventions (Collaborative Therapy)

Conversational Questions: Understanding from Within the Dialogue "Appropriately Unusual" Comments Mutual Puzzling Questions and Process: "Kicking Around" New Meanings Being Public: Therapists Inner Dialogue Accessing Multiple Voices in Writing- having a client write a letter to themselves

Interventions Continued... (Solution Based Therapy)

Coping Questions --This is so hard - how have you kept it from getting worse? Exception questions --Are there times when this doesn't happen? Miracle, Crystal Ball, Magic Wand, and Time Machine Questions --If you go to bed tonight and a miracle happens while you are asleep, and when you wake up in the morning your problem is solved, how will things be different? Compliments and encouragement

Triangulation (Bowenian)

Couples (or a family dyad) bring in a third party to relieve the anxiety within the dyad Concept: couple as two poles, back and forth, when becomes unstable, bring in a third party for balance and stability This third party becomes the boundary keeper (or peace keeper) Most common third party is a child Other triangles: affair, in-law, therapist, co-worker Examples: mom-child dyad, dad in peripheral wife-husband dyad, mom-in-law in peripheral mother-child dyad, sibling in peripheral Often a source for affairs

Creating a TG Frame (Bowenian)

Creating a TG Frame by the use of a genogram as an intervention that encourages self-disclosure and vulnerability Genogram allows families to learn more about and gain a new perspective of their own FOO and each other's FOO Genogram helps create this TG frame as it puts an emphasis on FOO

Assessment (Haley and Madanes)

Problem definition From view of each involved Structural arrangements within the family Triangles and coalitions What is the payoff for each member? Is power obtained? Attention?

Emotional Cutoff Continued... (Bowenian)

Cutoff can be considered as a continuum The mild form is part of differentiation Establishing distance in order to create differentiated self The extreme is cutoff The mid form is "tearing away" in order to create a psuedo self (The teenager raised in the church that becomes an atheist) This is different from "growing away"

Circumplex Model

David Olson - stems from his research on families and pre-marital couples Assesses both couple relationship and family of origin Two Axes: Flexibility Closeness

Assessment (MRI Brief Therapy)

Define a resolvable complaint Get a picture of the complaint - from each person involved "If we had a video of this, what would I see?" Identify attempted solutions that maintain the complaint Helps develop conceptualization of interaction cycle Understand the clients' language for describing the problem Helps define interventions in the family's language

Symbolic-Experiential Therapy

Developed by Carl Whitaker Began in the 1940's as early pioneer in working with families Shifted from conceptualizing client problems as internal conflicts toward viewing problems as part of dysfunctional interactions This therapy relies on emotional logic rather than cognitive logic Focus is on: The emotional process Family structure Balances strong emotional confrontation with warmth and support

Attachment Theory

Developed by John Bowlby Based on the concept that we have an innate need for others We seek closeness of others when we are stressed Definition: Biological, psychological, & social connections between a child and caregiver(s) "Will you be there for me?" "Can I depend on you when I need you?" How the caregiver(s) responds to these questions sets the stage for attachment. Smiles, eye contact, touch, holding, positive affect, rocking, etc.

McCubbin's Family Stress Model

Developed by husband and wife Found resiliency factors that help a family maintain resilience in the presence of stressful events

Global Assessment of Relational Functioning: 3 areas of assessment

Problem solving: skills in negotiating goals, rules and routines; adaptability to stress; communication skills; ability to resolve conflict Organization: Maintenance of interpersonal roles and subsytem boundaries, hierarchical functioning, coalitions and distribution of power,control and responsibility Emotional Climate: tone and range of feelings; quality of caring, empathy, involvement, and attachment/commitment, sharing of values; mutual affective responsiveness, respect, and regard; quality of sexual functioning

Theodore Lidz

Did not believe that mothers caused schizophrenia Identified 2 types of marriages - both leave kids feeling responsible to balance the marriage

MRI Brief Therapy Continued...

Did not identify a clear picture of normality due to the broad variance in families Goal: to eliminate problems Focus on circularity in communication Family may encounter a "problem" and how each member responds determines if it continues or not ... or if the family gets stuck in the pattern. Failed attempts at problem solving maintain the "vicious cycle" Role of therapist: one-down stance

Whitaker Assessing Emotional Process

Differentiation and Individuation Tolerance for conflict Conflict resolution and problem solving Sexuality: Is it expressed or not? Loyalty and commitment Parental empathy Playfulness, creativity, and humor Cultural adaptations Symbolic process- If someone is late to therapy, what does that symbolize? If only two of the family shows up, what does that symbolize?

Overview of Narrative Therapy

Dominant Discourses We "story" and create meaning of life events using available dominant discourses - broad social stories, practices, assumptions, and expectations about how we should live "Problems" Experienced when a person's personal life does not fit with these societal discourses and expectations Externalization Process involves separating the person from the problem

Case Conceptualization/Assessment (Narrative Therapy)

Problem-saturated stories --People define themselves by the problems Unique outcomes and sparkling events Dominant cultural and gender discourses Local and alternative discourses: Attending to client language and meaning

Symmetrical relationships

Don Jackson Based on symmetry and equality eg: both work, share chores, etc.

Family rules

Don Jackson Idea that families follow the underlying rules - and only use a small range of behaviors Identified that family patterns maintain symptoms -Functional vs. Problematic -Asking the family what secondary gains would be -Secondary Gain: Dealing with the root problem Scapegoat -May be the "identified patient"- the one that "brings" the family into counseling -Idea that families take out symptoms on one individual -Frequently the child (can also be viewed as the symptom carrier)

Complementary relationships

Don Jackson Partners are different but they fit (like a puzzle) Logical, emotional Weak, strong

Benefits of Enactments (Structural Therapy)

Providing in vivo practice and experience with new interactions and family patterns REDUCING THE ILLUSION that the problem belongs to a single person Increasing the family's sense of competence and strength by successfully engaging in new preferred behaviors (highlighting the things they're doing well)

Ivan Boszormenyi-Nagy

Psycho-analytical roots Father was an accountant Contextual therapy

EFT: The Therapeutic Relationship

Empathetic Attunement Acceptance Genuineness Continuous Monitoring of the Alliance- (Even asking the client after a session or two: Do you think this relationship will work?) Joining the System Therapist Role Expression of Empathy: RISSSC

Solution Focused Assumptions

Every client is unique Clients have the inherent strength and resources to help themselves Nothing is all negative There is no such thing as resistance You cannot change clients; they can only change themselves. Solution Focused Therapy goes slowly There is no cause and effect Solutions do not necessarily have anything to do with the problem. Emotions are part of every problem and every solution Change is constant and inevitable; a small change can lead to bigger changes. One can't change the past so one should concentrate on the future

Working with Diverse Populations (Structural Therapy)

Excellent support for working with diverse populations Structural family therapy employs an active, engaged approach in which the therapist often takes an expert stance in relation to the family, an approach that often fits with the values of traditional cultures

Case Conceptualization/Assessment (Solution Based Therapy)

Exceptions and "What Works" Strengths and Resources Client Motivation: Visitors, Complainant, and Customers --Visitors: usually brought to therapy by an outside other such as spouse, parents, courts (They don't really want to be there) --Complainants: identify a problem but expect therapy or some other person to be the primary source of change (The mother that brings her son in and wants you to fix them) --Customers: identify a problem and want to take action towards the problem

The I-position (Bowenian)

Rather than blaming or criticizing, the individual takes responsibility for his/her feelings and thoughts Goal is to decrease blame and attack within relationships

Two major questions of each theory

Family Processes What are the explicit and implicit assumptions about normal - typical and optimal - family functioning and views of dysfunction? Therapeutic Goals and Change Processes How do these beliefs influence therapeutic goals and objectives and intervention processes?

Systemic Assessment Application

Family Processes What are the explicit and implicit assumptions about normal - typical and optimal - family functioning and views of dysfunction? What do you consider to be "normal" family functioning? What are signs of health in families? What do you consider to be "dysfunctional" family functioning? What are red flags or signs of struggle?

Working Concepts Continued...

Family Structure -The organization of the family Subsystems (THIS IS WHAT WE REALLY WANT TO KNOW ABOUT) -Parents -Kids -Athletes -Other ideas? Boundaries- "I talk to Mom about this and Dad about this" -Lines within families that explain how to communicate, act, express emotion -Disengaged -Enmeshed

Whitaker Goal Setting

Family cohesion --Increase cohesion to create a sense of nurturance and confidence in problem solving Developmental tasks --Promote completion of developmental tasks to promote personal growth Symbolic world --Expand the family's symbolic world by expanding their meaning of experience

Jay Haley

Family communication -Different levels of communication at the same time Go clean your room ... what does it really mean? Directive therapy -Telling people to do what they fear

Family Closeness (Circumplex Model: Closeness)

Family members ask each other for help. Family members approve of friends. Our family likes to do things with each other. Family members enjoy being together. Our family likes to spend free time together. Family members feel close to one another. When our family gets together for activities, everyone is present. It is easy for us to think of things to do together. Family members consult on decisions. Family togetherness is very important to our family.

Circumplex Model: Flexibility Family Flexibility

Family members compromise when problems arise. Our family is flexible in how discipline is handled. When there are problems, our family becomes disorganized. Things never seem to get done in our family. Our family is able to adjust to change when necessary. Parents and kids make decisions together in our family. Our family has a hard time finding good ways to solve problems. Our family shifts household responsibility from person to person. We never seem to get organized in our family. Our family has a rule for every situation.

Murray Bowen

Father of the genogram Initially specialized in schizophrenia - Menninger Clinic Heavy emphasis on theory, less emphasis on intervention Differentiation of self -Independence from others - emotionally, cognitively, etc. Triangles -Bringing in a 3rd person to relieve tension (Amanda's example of her friends Sara and Kristi) Emotional reactivity of families -Inability to think clearly because of emotion Families will pull therapists into this emotion

Virginia Satir

First family therapist to really look at emotion Focus on communication and emotion Conceptualized families as stuck in narrow roles Goal was to free family members from these roles

Double Bind (Palo Alto Group)

First identification of the family's influence on behavior observed initially in schizophrenic individuals This idea of "do this but don't do this" Contradictory messages within an intimate relationship that lead to conflict Example: mom stiffens when son gives a hug, son withdraws, mom says "don't you love me?", son embarrassed, mom criticizes son's feelings -Wife that says "please do the dishes, then says why aren't you spending time with me?"

Overview of Strategic Therapy Continued...

First order and second order change Behavior change vs family rules change (or heart change) Reframes Making a different interpretation of the behavior Eg: child seeking attention from parents rather than being an unruly child Behaviors in families developed to maintain homeostasis: Function of the system Overall goal of therapy is to improve communication patterns This can be done by identifying sequences OR by blocking the sequences

Cybernetics

Focus on the following: Homeostasis Family rules Negative feedback Positive feedback Sequences of family interaction See the model in the first day power point that models the cycle

Circumplex Model Examples

For further information... Prepare-Enrich Online Chapter 19 Walsh text Article on Angel

Nathan Ackerman

Forerunner in promoting family therapy Unique in that he focused both on family relationships and individual considerations Therapy including provoking families to address issues commonly avoided (such as sex and aggression)- usually danced around in family therapy "He never lost sight of the self in the system."

Interventions Continued... (Solution Based Therapy)

Formula First Session Task --Between now and the next time we meet, I would like you to observe, so that you can describe to me next time, what happens in your family/life/etc that you want to continue to have happen. Scaling questions for weekly task assignments --On a scale of 1-10... Pre-Suppositional questions and assuming future solution --What will you be doing differently when these issues are resolved?

Interventions (Solution Based Therapy)

Formula First Session Task --Between now and the next time we meet, I would like you to observe, so that you can describe to me next time, what happens in your family/life/etc that you want to continue to have happen. Scaling questions for weekly task assignments --On a scale of 1-10... Pre-Suppositional questions and assuming future solution --What will you be doing differently when these issues are resolved?

Collaborative Therapy

Founders Harlene Anderson and Harry Goolishian developed Collaborative Therapy Lynn Hoffman as well Overview --Two-way dialogical process (walking through something WITH a client) Explore and co-create new and more useful understandings related to client problems --Focus on the process of therapy How ideas are exchanged --Client's Worldview Therapist tries to understand the client from within the client's worldview

Overview of Structural Therapy

Generally therapists will alternate between phases two and three many times revising and refining Structural therapists prefer to begin therapy with the ENTIRE family to assess the system. After assessment, therapist may meet with specific subsystems (couple, child, individual, etc.)

Assessments

Genogram Earlier lecture Begins with first phone call (who's making the phone call?) Who comes to session? Who talks more? Verbal and nonverbal communication Process vs content

Assessment:Genogram

Genogram will include 3 generations Used to point out patterns, current problems, problem history: mainly focusing on multigenerational patterns Patterns may include mental health, physical health, work, spirituality/religion Also looking for major/critical incidents, key figures in FOO, important events in FOO, and the history of the marriage (also think DATES or TIME LINES) Have each individual give own perspective of presenting problem (including how FOO has responded to problem) Genogram helps therapist think long-term regarding treatment goals Therapist to be culturally aware when assuming health of FOO and system Part of this awareness includes social class, religion, culture

The process question (Bowenian)

Goal is to slow the client down, decrease anxiety, and get the client to start thinking differently Examples: When your mom calls you and nags, how do you handle it? What happens when your family is all together? Is this a pattern in your dating relationships?

Goal Setting (Solution Based Therapy)

Goal language - positive, measurable and concrete Meaningful to client Interactional Situational Small steps Clear role for client Realistic Legal and ethical Solution-Generating Questions: Miracle, Crystal ball, Magic wand, and Time machine questions work best when therapist: --Prepares client for a solution-generating question (like training the client to think positively from the beginning) --Creates a compelling vision --Asks for behavioral differences Small steps: Scaling questions for goal setting One Thing Different: Client-generated change (you can only ask the client to do one thing different)

The Palo Alto Group

Gregory Bateson/Schizophrenia Research Don Jackson & Jay Haley Focus on communication Meta-communication 2 levels of communication/messages Report and Command Meta-communication is the implied command E. g.,: clean your room (message is "you never do anything right and I have to remind you of everything")- layered communication; listen on multiple levels Or: I thought you were going to call when you got off work.

Strategic: Haley and Madanes

Haley & Madanes believed that labeling the problem or telling the family what to do leads to resistance Madanes: "If a problem can be solved without the family's knowing how or why, that is satisfactory." Haley focused on the meaning of the problems, interactions, and behaviors. Also focus on power distribution within the family My note: Different from Bowen because the therapist does things without telling the client why; there is no psycho-education involved. All SYMPTOM focussed

EFT: Softening Emotions

Hallmark EFT technique used to create emotional bonding, change interactional positions, and redefine the relationship as safe and connected Softening refers to the more critical partner softening his or her stance and words allowing the other partner to reduce their reactivity

Pretend Techniques (Haley and Madanes)

Have family to pretend to have the symptom together. Eg: telling lies

Assessing for family's view of functioning

How do members view their own family as a system and each individual? How do they believe others view the family? How do they believe others view the individuals within the family? How do they compare their family to other families? How do they compare their family to overall society's views on families?

#2 Family Organizational Patterns (Resilience)

How the family organizes to meet challenges Flexibility (Metaphor of a tree; the branches can move and sway and still stay rooted) -Openness to change -Stability through disruption -Strong authoritative leadership (provides the stability) --Nurturing, protecting, guiding --Cooperative co-parenting, equality in parental subsystem

#1 Belief Systems (Resilience)

How the family views a crisis, suffering, or options Making Meaning of Adversity Families view it as a family problem vs. individual problem Normalizing stress vs. being victimized (believing that bad stuff will happen; how are we going to make sense of it) (Resilience comes from accepting that we live West of Eden) Coherence: work together, look at context Positive Outlook Sense of hope, learned optimism Helps to encourage families strengths during a crisis Accept what can't be changed Transcendence and Spirituality -Connection with something larger- making sense of the nonsensical -Faith community -Inspiration Paradox of Resilience -The worst of times can also bring out the best

Satir's Therapeutic Relationship

Humanistic and Systemic Foundations Therapeutic Presence: Warmth and Humanity- Just be you; dress-wise, personality, etc. Making Connection Conveying Hope Establishing Credibility- letting them know what you're talking about; you might even explain your credentials casually to join with them and also showing them you know what you're doing

Circumplex Model

Hypotheses of the model Balanced couples and families will generally function more adequately across the family life cycle than unbalanced types. Not functioning in extremes of either flexibility or closeness If a couple's/family's expectations or subcultural group norms support more extreme patterns, families can function well as long as all family members desire the family to function in that manner.

Circumplex Model

Hypotheses of the model Positive communication skills will enable balanced types of couples/families to change their levels of cohesion and flexibility. Poor communication prevents movement in families Couples/families will modify their levels of cohesion and/or flexibility to deal effectively with situational stress and developmental changes across the family life cycle.

Working with Diverse Populations

Ideal for marginalized populations, approaches focus on how the client's problems relate to the broader socio-political context The local discourse focus of Collaborative therapy ensures that the client's cultural values and beliefs are central to the therapy process Both Narrative and Collaborative Therapy have international roots and are practiced in numerous countries around the world

Salvador Minuchin

Identified 2 patterns in families Both patterns lack clear authority Enmeshment Parents over-involved; no hierarchy or line between parent and child Disengagement Parents not involved

Strategic: Haley and Madanes

Identified a concept of normalcy within families. Goal was to create more functional boundaries and hierarchies. Rules within parental hierarchy set the tone for the family (for example, the parents shut the door every night; or Summer wanting me to read to her during dinner) Haley believed that problems frequently stemmed from "disturbed hierarchies" within families Interventions were specific to the family ... and creativity was a heavy influence

Don Jackson

Identified family homeostasis

Early Phase Checklist

Identify major conflicts and identify them Treatment plan Balance focus on problem, interpersonal relationships Homework Identify family roles Push for change in session and out of session

Positive connotation (Milan Systemic Model)

Identify positive impact of behaviors - how it's protecting the family Presented to family as a hypothesis ... including how behavior is protecting the family Eg., thanking the child for being symptom carrier- a better way might be to thank the child for serving the role rather than carrying/performing the symptom

Middle-phase checklist

Increase intensity in session (balance with empathy) Balance of direct and indirect communication with family Increase individual responsibility within system Strengthen family bonds Assess therapist role Maintain systemic perspective (be ready to watch someone revolt at the attempt of changing the system)

Families with teens

Increasing flexibility of boundaries to enhance children's independence and grandparents needs Changes Required: Shifting of relationships to allow teen to move in/out of system Refocus on midlife marital and career issues Caring for grandparents

EFT: Case Conceptualization

Intrapsychic and Interpersonal Focus --Intrapsychic: how individuals process their experiences --Interpersonal: how partners organize their interactions into patterns and cycles Attachment and adult love Primary and secondary emotions (Hurt that is below anger) Negative interaction cycle

Intervention (MRI Brief Therapy)

Introducing the treatment setup Inquiring about & defining the problem Estimating the behavior that is maintaining the problem Setting goals for therapy Selecting and making behavioral interventions Termination Reframe problems so family understands Paradoxical interventions -Symptom prescriptions: increase intensity of symptoms (or make more grandiose) -Goals: for client to rebel or for family to get tired -Example: act more angry as a family... family gets tired, thinks it's ridiculous, or finds alternative solutions; the mother knows her daughter is going to throw a fit in the grocery store and tells the child "is that all you got?"

Overview of the Therapy Process (Narrative Therapy)

Involves finding new ways to view, interact with, and respond to problems by defining the role of the problems in their lives Broadly involves the following phases: Meeting the person Listening Separating persons from problems enacting preferred narratives Solidifying Process thickens and enriches a person's identity and life accounts

Case Conceptualization (Collaborative Therapy)

Involves two key questions - 1. Who's Talking? Problem-Organizing, Problem Dissolving Systems Multiple perspectives are collected defining the problem allowing the participants' understanding of the problem to evolve 2. Philosophical Stance: Social Constructionist Viewing Focus is always on how clients construct meaning about the events in their lives, their worldview. How are you making sense of life right now?

End-phase checklist

Is presenting problem improving/decreasing? Is family happy/satisfied with treatment? Family able to articulate progress? How is family handling current stressors? Are relationships within and without family system strengthened? Predict future problems.

Milan Systemic Model (Strategic Therapy)

Italian Psychotherapists Mara Selvini Palazzoli Luigi Boscolo Gianfranco Cecchin Guiliana Prata Focus started on eating disorders ... then led to the incorporation of the family Included male-female co-therapists and observers Therapists have an attitude of neutrality: rather than having preconceived notions of normal, ask questions that lead to families examining selves ... with the hope that families would reorganize themselves.

Strategic Therapy: Haley and Madanes

Jay Haley Worked with MRI, then studied with Minuchin, then developed his own model More strategy and a sense of almost manipulation in his view of therapy Cloe Madanes worked at both MRI and Child Guidance (with Minuchin) Considered to be one of the most creative therapists of our time

The Therapeutic Relationship (Structural Therapy)

Joining and Accommodating Joining as an attitude Mimesis- using the language of the family Therapeutic spontaneity --Ability to be authentic and flow with therapy Therapist use of self "Make it happen" --Play what role is needed More recent adaptation: softer style

Child Guidance Emphasis

Kids were historically treated individually ... families were viewed as an extension of children Mothers were sometimes seen separately from their children but the social workers/psychiatrists did not collaborate Parents were frequently blamed (esp. mothers) Term: schizophrenogenic mother- Thought that mothers cause schizophrenia- 1950s Bowlby worked some with families.. But Nathan Ackerman was the one to take the lead

First session checklist

Listen to each family member's point of view- don't let one person talk the whole time Establish leadership - pacing and control; you have to be the one in charge Working alliance Identify resilience and strengths Empathy Identify problems and solutions Develop hypotheses- you're always working on a hypothesis Assess for extended family or other members Explain Treatment- "They're may be times when I just work with your daughter, but sometimes I'll want to see you as parents." Ask for questions

Psuedomutuality

Lyman Wynne "a façade of togetherness that masks conflict and blocks intimacy" No room for uniqueness or separateness Avoidance of deep, intimate relationships

Psuedohostility

Lyman Wynne Arguing and bickering that hides "pathological alignments" in families Appears to be separateness but that is a façade Prevents open communication and quality relationships

"Rubber Fence"

Lyman Wynne Observed in these families Keep outsiders out, and insiders in... with the appearance of being open These families became "sick little societies" May present as seeking help... but not let clinician in

Carl Whitaker

Referred to as "irreverent" "turned up the emotional temperature" in therapy

EFT: Interventions

Reflection of emotion (Reflections can help people stop to sit in their emotions) Validation Evocative responding: Reflections & Questions Heightening- Sitting with their feelings Empathetic Conjecture and Interpretation (If they continue to reject your discernment and you know you're right, you might have to slow down)

Global Assessment of Relational Functioning

Relational guide to levels of functioning Global Assessment of Relational Functioning (GARF) Added to the DSM-IV in 1994 Rate the degree to which a family or other ongoing relational unit meets the affective or instrumental needs of its members in the following areas:

Satir's Goal Setting

Relationally focused goals: --Develop ways for all members to communicate congruently Individually focused goals: --Promote self actualization of all members --Emphasis to individual level is unique amongst systemically based therapists

Case Conceptualization/Assessment (Structural Therapy)

Role of symptom in the family Subsystems- looking at different relationships/roles within the family Cross-generational coalitions Boundaries Hierarchy Complementarity- if you have a good child, you need a bad child, etc. Family life cycle development Strengths

Boundaries (Structural Therapy)

Rules for managing physical and psychological distance Clear boundaries Refer to a range of normal - a balancing of closeness and distance Enmeshment and Diffuse Boundaries -Overly involved leading to symptoms Disengagement and Rigid Boundaries -Overly distant leading to symptoms

Structural Therapy Contributors

Salvador Minuchin Originator of structural therapy, psychoanalytic work emphasized interpersonal relationships Wiltwyck School He and colleagues Dick Auerswald, Charlie King, Braulio Montalvo, and Clara Rabinowitz worked with families Jay Haley Collaboration 1962, Minuchin visited the MRI befriending Jay Haley becoming an influential relationship developing the Structural and Strategic approaches of family therapy Influential students & colleagues Harry Aponte, Jorge Colapinto, Charles Fishman, Jay Lappin, and Michael Nichols, Marion Lindblad-Goldberg Succeeded Minuchin as Director of Philadelphia Child & Family Therapy Training Center Developed empirically supported Ecosystemic Structural Family Therapy Jose Szapocznik Colleagues develop empirically supported Brief Strategic Family Therapy (BSFT)

Triangulation Continued...

Secondary triangles: when 2 or more individuals ally as one corner of a triangle temporarily, on perhaps 1 issue only. Example: initial triangle of mom, dad, and son; MGM sides with mom and son on an issue, creating a secondary triangle The third person in the triangle is frequently pushing for change Example: child is acting out at school because of triangulation with mom-dad dyad Class discussion: Examples of triangles? Either in personal life or in media

Goal Setting (Collaborative Therapy)

Self-Agency Increase sense of agency, sense of competence and ability to take meaningful action Transformation During therapy, some "original" aspects remain while other aspects are added or diminished Setting Collaborative Goals Therapeutic goals included in a treatment plan are constructed collaboratively with clients using everyday language

Societal Emotional Process

Society's impact on family emotional processes Consider current economical, political, cultural, and societal issues that may be impacting the couple or family Example: A Bowen Couples Therapist would consider the influence on a recent school scandal and how it may be impacting the parent's anxiety about a child

Overview of Therapy Process (Solution Based Therapy)

Solution-based therapists help clients identify their preferred solution by: Talking about the problem, exceptions, and DESIRED OUTCOMES Working with clients to take SMALL ACTIVE STEPS in this general direction each week This can take 1 - 10 sessions or it may take years depending on the complexity of the case

Assessment (Bowenian)

Specific interventions not clearly articulated; this approach is heavy on theory Remember that changes within the family system will radiate out to extended family of origin Assessment occurs within first 1-3 meetings, Genogram will be major tool used for assessment

FOO Consults-Structure

Spouse being visited explains presenting problem within the marriage FOO encouraged to ask questions and explain what they know (emphasis is on spouse and not on FOO) Each consult is different, depending on emotional tone and communication of FOO Some FOOs resistant to discuss whereas others jump right in Consults often increase spouse's awareness of what he/she has brought to marriage After a consult the spouse is frequently more self-focused and willing to look at his/her own contribution to current problem

Assessing Client Strengths (Solution Based Therapy)

Strengths include resources in a person's life, personally, relationally, financially, socially, or spiritually and may include family support, positive relationships and religious faith Clients often have greater difficulty identifying areas without problems in their life; Train clients to think positively Strengths are assessed in two ways --By directly asking about strengths and areas of life that are going well --By listening carefully for exceptions to problems and for areas of unnoticed strength

Research/Evidence Base for Solution Based Therapy

Strong, growing evidence base for the model Three key practical and philosophical challenges of establishing solution-focused --Difficult to adequately manualize and capture the spirit and epistemological positioning that is essence of the model --Shallow adherence to techniques without grounding in the theory results in an inaccurate enactment of the therapy --Certain philosophical principles such as honoring each clients uniqueness and recognizing change processes outside of therapy are at odds with the making global assessments of the effectiveness of this approach

Prescribing Ordeals (Haley and Madanes)

Suggesting family members to do something each time a behavior occurs Eg: Insomniac has to clean or pay bills when can't sleep Eg: page 112 book Cloe Madanes on Couples Therapy- video clip

EFT Contributors

Susan Johnson with Les Greenberg developed EFT in the 1980's by refining methods based on the outcomes of their research on what worked and what did not Sue Johnson has continued research on the model and teaches internationally Les Greenberg has refined a version of the model he calls Emotion-Focused Therapy

Interventions (Structural Therapy)

Systemic reframing --Removes the blame from one person --Identifies circular causality --Re-describing the problem Enactments & modifying interactions Boundary making Challenging family's worldview Intensity and crisis induction (when you're really pushing a family- bringing feelings into the mix) Unbalancing the Family System ("Okay Mom, you can't discipline this week. Only Dad can do that.) Expanding family truths & realities (See things that are already healthy and capitalizing on it. If family night is working well, how can we do more of that?) Compliments & shaping competence

Family of Origin Consult

TG therapist arranges the consult during the mid-phase of therapy Helps family make the connection of problem to FOO FOO meetings only occur once or twice due to financial/time constraints 2 hour segments over 2 consecutive days Frequently increases anxiety so family needs to be prepared for this visit One family of origin at a time Spouse just observes and does not participate Spouse invites own FOO to the experience Siblings frequently do not attend (though they are asked)

Tracking the Presenting Problem

TG therapist is observing power distribution, decision-making, story-telling, naming of the problem Structural characteristics of the family are observed: distance, fusion, disengagement, cutoff, conflict

Tracking Antecendents

TG therapist tracks problem while observing what event triggered the current problem Consider antecedents within whole system as well as dyads and within each FOO Tracking 3 generations of family - acknowledges another dimension of the experience and presenting problem Helps clients get to the root of things: see how FOO had an impact on the current dilemma

Commonalities of Experiential Theories

Targeting Emotional Transactions focus on the emotional layer of problematic interactions Warmth and Empathy Self of Therapist Individual and Family Focus Therapist addresses both individual and family concerns as distinct sets of problems

Enactments (Structural Therapy)

Technique where therapist prompts family to reenact a conflict or other interaction- Dr. Grieme actually gets her families to fight- you see so much in an argument One of the most important techniques to master Occurs in three phases: -Observation of Spontaneous Interactions -Eliciting Transactions -Redirecting Alternative Transactions

Prescribing the symptom (Haley and Madanes)

Telling a client to do a problem behavior Shifts the behavior from involuntary to voluntary Two possible outcomes: Does the behavior and proves it is voluntary Gives up the behavior all together Considers the interpersonal payoff of the behavior

EFT: RISSSC Conversations

The RISSSC technique is designed to express understanding of the client's affective reality The technique uses the following steps: Repeat (example: stopping a talker by looking for their emotions and highlighting those by stopping their detail giving) Image (giving an image to the emotion someone is giving) Simple Slow Soft Client's Words

Experiential Therapies- Three Primary Approaches

The Satir Growth Model Focus on communication Symbolic-Experiential Focuses on symbolic meanings and emotional exchanges Emotionally-focused Couples Therapy Leading evidence-based approach to couples therapy

Multigenerational Transmission Process (Bowenian)

The concept that levels of differentiation are taught (implicitly and explicitly) to younger generations of family members As a result, family members become less and less differentiated as time goes on Example: If a married couple focuses on one of their children excessively, this child will marry a similar individual with low differentiation. They will transmit this to their child, and the pattern will continue among generations. Bowen saw this with the schizophrenic families he was working with Low differentiation within a family system can lead to marital distress, dysfunction in a spouse, or dysfunction with a child

Cybernetics

The tendency of families to maintain stability Feedback loop How a family gets information to maintain stability - steers the family towards homeostasis -Example: husband takes out the trash, wife nags, etc.; it is an interaction that repeats itself every week Negative feedback Return to stability or normal - no new information Status quo within the family- maybe the husband doesn't get angry and instead ignores the wife, but still takes out the trash. Positive feedback Attempt to change - only means new information, not necessarily good/positive 2 outcomes: former homeostasis OR new homeostasis Common response: getting back to normal Death, fighting, graduation, re-marriage

Marital Schism

Theodore Lidz -Husband and wife undercut each other's worth and/or compete openly for attention/affection of the children Example: Devon (presented as a child problem)- parents fought over who took the best care of their child

Marital Skew

Theodore Lidz -One parent is a "pathologic bully" and the other is passive/dependent; think military father -Example: Self-centered father appearing as dominant but is actually very bullying

Assessment (Milan Systemic Model)

Therapist starts with a hypothesis Confirmed or disconfirmed in 1st session Based on "identified patient" Assessment questions focus on family as a set of interconnected relationships Goal: develop a systemic perspective of problem

Role of the Therapist

Therapy occurs in stages/phases so therapist role changes Therapist seen as coach throughout In the beginning, more directive Mid-phase, increased use of self as couples begin to look at key relational/FOO issues Late-stage, less coaching/expert stance as couple begins to solve problems on their own

EFT: Interventions Continued

Tracking and Reflecting Interaction Patterns Reframing Problems Contextually (Looking at the system- what is the function of your problem) Enactments, Restructuring, and Choreography Turning New Emotional Experience into a New Response to the Partner (Trying to move an emotional connection with you to the other family member) Self-Disclosure Sue Johnson on EFT

Process vs. Content

Two different areas of focus Content: what is being said What the argument is about (eg., curfew) Process: the deeper meaning, message, and interactions used How the family argues? What messages are sent? Mom withdraws, Dad lectures, Kid is aggressive The temptation is to get caught up in the content!!

Circumplex Model: Closeness

Unbalanced: Disconnected - too much (I) separateness - little closeness - lack of loyalty - high independence Balanced: Somewhat Connected to Very Connected - good I-We balance - moderate to high closeness - moderate to high loyalty - interdependent Unbalanced: Overly Connected - too much (We) togetherness - too much closeness - loyalty demanded - high dependency

Circumplex Model: Flexibility

Unbalanced: Overly Flexible - too much change - lack of leadership - dramatic role shifts - erratic discipline Balanced: Somewhat Flexible to Very Flexible - can change when necessary - shared leadership - role sharing - democratic discipline Unbalanced: Inflexible - too little change - authoritarian leadership - roles seldom changed - strict discipline

Contributions to the Field (Narrative Therapy)

Understanding Oppression: Dominant vs. Local Discourses Dominant discourses are culturally generated stories about how life should go Local Discourses occur in our heads, our closer relationships and marginalized communities Narrative therapists help clients become aware of how these different discourses are impacting their lives

Circular Questioning (Milan Systemic Model)

Used to highlight differences among family members Example page 114- shifting from the child being the problem to a circular interaction that looks at a bigger picture

Satir's Overview of Therapy Process

Uses a six-stage model of change - 1. Status Quo 2. Introduction of Foreign element- (Which is the therapist; or someone gets married, etc.) 3. Chaos (they don't know what to do) 4. Integrating new possibilities 5. Practice 6. New status quo

Circumplex Model: Flexibility Couple Flexibility

We compromise when problems arise. We are creative in how we handle our differences. In our relationship, we share leadership equally. Both of us are able to adjust to change when it's necessary. We try new ways of dealing with problems. We make most decisions jointly. We seldom seem to get organized. We will share household responsibilities equally. We have difficulty completing tasks or projects. We are flexible in our lifestyle.

Couple Closeness (Circumplex Model: Closeness)

We really like to do things with each other. We ask each other for help. We spend too much time with our friends or relatives. We share hobbies and interests. Jealousy is an issue in our relationship. My partner & I really enjoy spending our free time together. We feel very close to each other. We find it easy to think of things to do together. We consult each other on all important decisions. Our togetherness is a top priority for us.

Curiosity

What is bringing this family in at this specific time? Assess for interaction patterns (circular vs. linear) Listen for process vs. content Very important to get each person's perspective How are other systems impacting the family? What is family structure like?

Role Theory

What roles are family members expected to play? Very difficult for family members to stop playing these roles -The perfect child -The rebel -The athlete Others?? Roles may become reinforcing: The good child is always good and the bad is always bad because neither gets the opportunity to be the other

Working with Diverse Populations (Solution Based Therapy)

Widely used with diverse populations in the US, Canada, and internationally Easily adapted for a wide range of value systems and communication styles Has been studied with a range of client ethnicities in a wide range of contexts Approach can be used to identify strengths to access unique emotional, cognitive, and/or social resources inherent within diversity

Differentiation of Self

main definition: the ability to experience difference the self in relation to, but separate from, others The ability to distinguish one's own thoughts and feelings as separate from others within the marital relationship, differentiation includes outside relationship with others but also a solid relationship with the spouse "In order to have resilience, partners have to possess a strong sense of personal identity that is not threatened by change." (p124) Differentiation is the cornerstone for healthy long-term commitments Individual differentiation influences the choice of the spouse A healthy marriage includes two individuals who are able to have a caring connection with FOO Bowen asserts that each individual brings his/her family of origin into the marriage

Good way to think about systems

one of those planets projects from elementary school. you can pull down Jupiter and work with it, but if you don't change the whole system, Jupiter is going to have a hard time staying changed, unless it intentionally affects change