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Family Systems Therapy

C6436 Individual Counseling


Theory and Practice
James J. Messina, Ph.D.
Family Therapists Leaders
 Alfred Adler-Rudolf Driekurs-open forum Child Guidance
Clinics
 Murray Bowen-Multigenerational Model-Triangulation,
Differentiation of Self
 Virginia Satir-Conjoint Family Therapy-Human
Validation, Relational Family Therapy
 Carl Whitaker-Experiential Symbolic Family Therapy-
therapist coach influences change
 Salvador Minuchin-Structural Family Therapy-create
structural change
 Jay Haley-Strategic Family Therapy-solves problems
now
 Cloe Madanes- Wife Haley-Strategic Family Therapy
The Family Systems Perspective
 Individuals ~ are best understood through
assessing the interactions within an entire family
 Symptoms ~ are viewed as an expression of a
dysfunction within a family
 Problematic behaviors ~
 Serve a purpose for the family
 Are a function of the family’s inability to operate
productively
 Are symptomatic patterns handed down across
generations
 A family ~ is an interactional unit and a change
)
in one member effects all members
Difference between Systemic &
Individual Therapy models
Individual Therapist Systemic Therapist

Obtain accurate diagnosis Explore System for family


DSM IV process & rules
Begin Therapy right now Invite in parents, siblings

Focus: causes, purposes, Focus: family relationships


processes
Concern with individual Concern transgenerational
experience & perspective meanings, rules
Intervene to help individual Intervene to change context
learn to cope within family system
Beliefs of Family Therapists
 Individual’s affiliations & interactions have
more power in person’s life than a single
therapist could ever hope to have
 Working with family or community
therapists sees how individual acts and
serves needs of these systems
 Seeing individual in active in a systems
assists in developing types of
interventions needed
Systemic Perspective
 Individual may carry a symptom for the entire
family
 Individual’s functioning is a manifestation of way
family functions
 Individual can have symptom existing
independent of family structure
 Symptoms always have ramifications for family
members
 Change the systems and individuals will change
 Change dysfunctional patterns of relating &
create functional ways of interacting & relating
Adlerian Family Therapy Outline
1. Key Concepts
2. Therapy Goals
3. Therapist’s functions
Adlerian Family Therapy Key
Concepts
 Adlerians use an educational model to counsel
families
 Emphasis is on family atmosphere and family
constellation
 Therapists function as collaborators who seek to
join the family
 Parent interviews yield hunches about the
purposes underlying children’s misbehavior
Family Atmosphere
 Unique: conjunction of all the family forces-
climate of relationships that exist between
people
 Family is a system & each member exerts
influence on every other member
 Autocratic or permissive common in West
 Parent role model of how genders relate, how to
work, participate in world
 Emotional role models for children as well
 Family value: value all members support &
cannot be ignored: religion, education, money
achievement, right and wrong
Family Constellation
 Consists of parents, children, extended
family members
 Birth order
 How member find place in family system &
how relate to one another to be unique
 Alignment of family members
 Develop genogram of family-starting point
for client communication meaning of life
Role of Birth Order
Motivates later behavior:
 First-born: favored, only, pseudo-parent-
high achievers
 Second-born: rivalry & competition
 Last-born: more pampered,
“baby”-creative, rebellious, revolutionary,
avant-garde
Birth Order
Adler’s five psychological positions:
 Oldest child ~ receives more attention, spoiled,
center of attention
 Second of only two ~ behaves as if in a race, often
opposite to first child
 Middle ~ often feels squeezed out
 Youngest ~ the baby
 Only ~ does not learn to share or cooperate with
other children, learns to deal with adults
Mistaken Goals: Interactional
View
 Four goals for children’s behaviors:
 Attention getting
 Power struggle
 Revenge
 Demonstration of inadequacy
 Short hand explanations, descriptions of
consistent patterns
 Describe child’s misbehavior
 Parent’s reaction to behavior
 Child’s reaction to parents’ attempt to discipline
 Mistaken Goal: recognition flex –smile, twinkle
 Goal recognition and disclosure
Adlerian Family Therapy Goals
 Unlock mistaken goals and interactional patterns
 Engage parents in a learning experience and a
collaborative assessment
 Emphasis is on the family’s motivational
patterns
 Main aim is to initiate a reorientation of the
family
 Assist family member to have Social Equality-
the sense that everyone has an equal right to be
valued and respected in the family
Adlerian Therapist Functioning
 Open forum
 Parent Interview alone they are leaders
 Problem Description parents concerns
 Goal Identification What did you do about it?
 Typical Day repeated patterns of interaction
 Child Interview
 Goal Disclosure Do you know why you do…
 Posit tentative goals: Could it be that…
 Concluding Remarks to generate new
approaches to end mistaken interactions to lead
to more democratic, harmonious, effective living
Multigenerational Family Therapy
Outline-Murray Bowen
1. Key Concepts
2. Therapy Goals
3. Therapist’s functions
Multigenerational Family Therapy
Murray Bowen 8 Key Concepts
 The application of rational thinking to
emotionally saturated systems. A well-
articulated theory is considered to be essential
2. Differentiation of the self
3. Triangulation
4. Nuclear Family Emotional System
5. Family Projection Process
6. Emotional cutoff
7. Multigenerational transmission process
8. Sibling position
9. Societal regression
Differentiation of the self
 A psychological separation of intellect & emotion
& independence of self from others
 Differentiated =Being able to be guided by
thoughts or emotions – separateness
 Undifferentiated=difficulty separating self from
others-fuse with dominant family emotional
patterns-physical but not emotional leaving
 Unproductive family dynamics of previous
generation transmitted by marriage of
undifferentiated individuals
 Need for self-identify while still belonging to
one’s family
Triangulation
 A third party is recruited to reduce anxiety and
stabilize a couple’s relationship
 Underlying conflict not addressed & worsens
 Once the 3rd person is resolved the balance
achieved is off again
 Change in one part of family system affects the
whole system
 Therapist must be highly differentiated so as not
to get caught up in triangulation with couple
Multigenerational Family Therapy
Goals
 With the proper knowledge the individual can
change
 Change occurs only with other family members
 To change the individuals within the context of
the system
 To end generation-to-generation transmission of
problems by resolving emotional attachments
 To lessen anxiety and relieve symptoms
 To increase the individual member’s level of
differentiation
Multigenerational Family Therapy
Therapist Functioning
 Genogram work: look at family over three
generations
 Look for critical turning points in family emotional
process
 Characteristics of family members
 Evolutional picture of family: tools for assessment
 Asking Questions: What role did you play with
that person in the family? Looking for fusion
within the family.
Conjoint Family Therapy Outline
1. Key Concepts
2. Therapy Goals
3. Therapist’s functions
Conjoint Family Therapy Key
Concepts-Virginia Satir
 Enhancement and validation of self-
esteem-Human Validation Process Model
Family rules
 Congruence and openness in
communications
 Sculpting
 Nurturing triads
 Family mapping and chronologies
Conjoint Family Therapy Goals
 Open communications
 Individuals are allowed to honestly report their
perceptions
 Enhancement of self-esteem
 Family decisions are based on individual needs
 Encouragement of growth
 Differences are acknowledged and seen as
opportunities for growth
 Transform extreme rules into useful and
functional rules
 Families have many spoken and unspoken rules
Family Life
 Children enter pre-existing systems which have
rules
 Rules about living & interaction
 Rules governing Communications-who says
what under what conditions
 Rules spoken and unspoken: shoulds and
should nots
 Rules become absolutes & often are impossible:
Never be angry with your father. Always keep a
smile on your face
 As child accept rules for survival which are not
useful as adult
Functional vs. Dysfunctional
Communications
 Functional: each family member give chance to
be individual, separate life – lots of freedom and
flexibility in family with open communications
 Dysfunctional: closed communications, poor
self-esteem of parents, rigid patterns-resists
awareness, strained relationships, little
individuality, incapable of autonomy or genuine
intimacy: Family members: think, feel and act
the same way: family controlled by fear,
punishment, guilt or dominance
Defensive Stances in Coping with
Stress
1. Placating-enabler, people pleaser,
rescuer
2. Blaming-troubled person
3. Super-responsible-looking good
4. Irrelevant behavior-distracting- acting
out, entertainer
Family Roles and Family Triads
 Roles played in family based on one’s behavior
 Victim
 Keeping the Peace
 Stern Taskmaster
 Disciplinarian
 Hard-working caregiver
 Nurturing Triad two parents and child where
child is nurtured
Conjoint Family Therapy Goals
 Communicating Clearly
 Expanding awareness
 Enhancing potentials for growth in self-esteem
 Coping with demands & process of change
 Identify new possibilities to the status quo
 Encouraging growth in each member
 Generating hope, courage to formulate new
options
 Assess, strengthen, enhance coping skills
 Encourage members to exercise healthy options
Therapist Functions
 Focus on emotional honesty, congruence,
systemic understanding
 Family sculpting: position family members
by roles they play in family
 Family reconstruction: psychodramtic
reenactment significant event in 3
generations of family-unlock dysfunctional
patterns stem from family of origin
Experiential Family Therapy
Outline-Carl Whitaker
1. Key Concepts
2. Therapy Goals
3. Therapist’s functions
4. Techniques
Experiential Family Therapy –
Carl Whitaker
 A freewheeling, intuitive, sometimes outrageous
approach aiming to:
 Unmask pretense, create new meaning, and liberate
family members to be themselves
 Techniques are secondary to the therapeutic
relationship
 Pragmatic and atheoretical
 Interventions create turmoil and intensify what is
going on here and now in the family
Experiential Family Therapy Key
Concepts
 Subjective Focus: subjective needs of the
family members
 Assumption all family members have a
right to be themselves
 Needs of family may be suppressing rights
of the individual
 Goal for authenticity, no right or wrong
way to be
Atheoretical Stance
 Pragmatic stance
 Theory can be hindrance to clinical work
 Often times theory is way for therapist to create
distance from clients and control anxiety of the
therapist to hide behind
 Intensify present experiencing of family
members to reach unconscious to understand
what is really going on in the family
 Process to help tap into: Family secrets just
keeping the secrets keeps the family crazy
Experiential Family Therapy
Goals
 Facilitate individual autonomy and a sense of
belonging in the family
 Help individuals achieve more intimacy by
increasing their awareness and their
experiencing
 Encourage members to be themselves by freely
expressing what they are thinking and feeling
 Support spontaneity, creativity, the ability to
play, and the willingness to be “crazy”
Therapist Function in Experiential
Family Therapy
 Create family turmoil
 Coach family how to get out of the turmoil
 Highly involved therapist model: must be
transparent, take risks, get involved with family
in the sessions
 Help family member experience the here and
now by therapist “BEING WITH” the family
 Three phases: engagement (all powerful),
involvement (dominant parent figure, adviser) &
disentanglement (more personal, less involved)
Structural Family Therapy Outline
- Salvador Minuchin
1. Key Concepts
2. Therapy Goals
3. Therapist’s functions
Structural Family Therapy -
Salvador Minuchin
 Focus is on family interactions to understand the
structure, or organization of the family
 Symptoms are a by-product of structural failings
 Structural changes must occur in a family before
an individual’s symptoms can be reduced
 Techniques are active, directive, and well
thought-out
 Focus on the how, when, and to whom family
members relate
Key Concepts Structural Family
Therapy of Salvador Minuchin
 Family Structure: invisible set of functional
demands or rules that organize way family
members relate to one another-
 Observe family to see the structure:
 who says what to whom,
 in what way,
 with what result
Family Subsystems
 Spousal: wife & husband
 Parental: mother & father
 Sibling: children
 Extended: grandparents, other relatives
 Family member play a different role in
each of the subsystems they belong
 Structural difficulty when one subsystem
takes over or intrude another
Boundaries
 Emotional barriers that protect & enhance the
integrity of individuals, subsytems & families
 Extremes of boundaries
 Disengagement-overly detached-rigid
 Enmeshment-very involved as one-diffuse-
fosters dependency on parents
 Clear healthy boundaries-attain sense of
personal identity yet allow sense of
belongingness within family system
Structural Family Therapy Goals
 Reduce symptoms of dysfunction
 Bring about structural change by:
 Modifying the family’s transactional rules
 Developing more appropriate boundaries
 Creation of an effective hierarchical structure
 It is assumed that faulty family structures
have:
 Boundariesthat are rigid or diffuse
 Subsystems that have inappropriate tasks and
functions
Structural Family Therapist
Function
 To actively engage family as unit to initiate
structural change by:
1. Joining the family in a position of leadership
2. Mapping its underlying structure
3. Intervening in ways designed to transform an
ineffective structure
 The Therapeutic Endeavor is challenging rigid
transactional patterns
1. Pushing for clearer boundaries
2. Increasing degree of flexibility in family interactions
3. Modifying dysfunctional family structures
Structural Family Techniques
 Joining: build & maintain therapeutic alliance
with family
 Family Mapping: draw map to identify
boundaries , transactional styles
 Enactments: family engages in conflict situation
that would happen at home
 Reframing: new light or different interpretation
on problem situation in family
Strategic Family Therapy Outline
1. Key Concepts
2. Therapy Goals
3. Therapist’s functions
Strategic Family Therapy Key
Concepts
 Focuses on solving problems in the present
 Presenting problems are accepted as “real” and
not a symptom of system dysfunction
 Therapy is brief, process-focused, and solution-
oriented
 The therapist designs strategies for change
 Change results when the family follows the
therapist’s directions and change transactions
Strategic Family Therapy Goals
 Resolve presenting problems by focusing
on behavioral sequences
 Get people to behave differently
 Shift the family organization so that the
presenting problem is no longer functional
 Move the family toward the appropriate
stage of family development
 Problems often arise during the transition
from one developmental stage to the next
Strategic Family Therapist’s
Function
 Therapist: consultant, expert, stage director-
change is therapist’s responsibility
 Use of Directives: designed to change the
system: advice, suggestions, coaching, giving
ordeal-therapy assignment
 Paradoxical Interventions: exaggerate or perfect
a problematic behavior
 Reframing: reinterpreting problematic behaviors
which are entrenched-giving new meaning to
behaviors may produce new behaviors that fit
the new interpretation
Social Constructionism
 The client, not the therapist, is the expert
 Dialogue is used to elicit perspective,
resources, and unique client experiences
 Questions empower family members to
speak, and to express their diverse
positions
 The therapist supplies optimism and the
process
Social Constructionism Therapy
Goals
 Generate new meaning in the lives of family
members
 Co-develop, with families, solutions that are
unique to the situation
 Enhance awareness of the impact of various
aspects of the dominant culture on the family
 Help families develop alternative ways of being,
acting, knowing, and living