Kuliah Model Terapi Keluarga

Lima Model Terapi Keluarga
Terapi Keluarga Bowen

Terapi Keluarga Struktur
Terapi keluarga Strategik
Terapi keluarga Experiential/ Komunikasi
Terapi Keluarga Tingkahlaku dan Tingkahlaku-Kognitif
Fauziah Hanim Jalal Ph.D KKT 2013 Kaunseling

Keluarga
Masyarakat Malaysia tradisional

Biar pecah di perut , jangan pecah di mulut
Fauziah Hanim Jalal Ph.D

KKT 2013 Kaunseling Kelua
Pengenalan
Working with family members, all or part, to
bring about change in the family organization.

It is complex and multifaceted - there is no
simple correct approach
Makes a shift from an individual to systemic
perspective (menyeluruh)

Basic Principles
Focus is on interaction and communication
An individual influences his context and is
influenced by it
Changes in organization/structure contribute
to changes in behavior
http://www.goldentriadfilms.com/films/tapes.ht
m

Roots
Psychoanalytic Approach (Freud) and Client-
Centered Therapy (Rogers) both treated

client in private to maintain purity of
therapeutic relationship

FAMILY VS. INDIVIDUAL

THERAPY:
Both offer an approach to treatment and a way
of understanding human behavior

Individual therapy focuses on internalized
influences of family and intrapsychic dynamics
Family therapy believes the dominate forces in
our lives are located externally in the family

Therapy focuses on changing the family
organization
When family organization is transformed, the
lives of every family member are altered
accordingly
Family therapy exerts change on the entire
family (not just individual in context)
improvements can be lasting because each
member is changed and continues to exert
change on each other
FAMILY THERAPY PROCESS

Family Assessment:
Some very formal with structured questions and genograms;
others conduct little formal evaluation
Presenting Problem:
What is family saying, what have they tried to do to solve
problem
Understanding Referral Source:

Expectations, agendas, etc
Identifying Systemic Context:
Who makes-up the family
Stage of Life Cycle:
Transitional issues
Samb.
Family Structure:
Who plays what roles in the family
Communication:
Process and content
Divorce, Domestic Violence, Sexual Abuse, Affairs

Explore safety issues, secondary issues
Gender, Cultural Factors,
Care:
Ethics: Managed
Assess to uncover issues, minefields Challenges, ethical issues

Family Therapy Pie
Psychodynamic
and Bowen
Behavioral
Strategic
Experiential
Structural
Communications

Bowen-Intergenerational Theory.
Intergenerational Family Therapy atau Bowen
Intergenerational Theory.
Murray Bowen 1950an, Kehidupan keluarganya
beri impak besar dalam teorinya.
Ahli terapis yang pertama menggunakan teori sistem
dalam terapi keluarga.
Bowen percaya sistem emosi wujud dalam keluarga
dan mempengaruhi generasi seterusnya dengan pola
berulangan.
Corak emosi emotionally overinvolved (fusion) atau
emotionally cut off pengelakkan fisikal atau
psikologikal)
Elemen penting teori- that here is a chronic
anxiety in all of life that comes with the

territory of living. Freidman, 1991, p.139.
Keluarga bermasalah anxiety tinggi (kronik)
stress, sakit fizikal / psikologi (boleh
dijangkakan)

Bowen-Intergenerational Theory
8 konsep asas:
1. Perbezaan Kendiri (Differentiation of Self)
- keupayaan seseorang membezakan dirinya dari
keluarga asalnya pada tahap emosi dan intelektual.
Kehidupan togetherness dan individuality
Negatif: Fused atau undifferentiated family ego mass.
Matlamat : Seimbang emosi dan kognitif.
Contoh: Pelajar kolej yang pulang untuk meraikan
perkahwinan kakaknya dan masa yang sama keluarga
mengalami konflik. Apakah darjah perbezaan
kendirinya?

Darjah Differention of Self :
1. below 50 (Low differentiation)
- tries to please others, seek others, bergantungan,
avoids conflict, lacks of capacity of autonomy.

2. 51-75 ( Midrange differentiation)
- has definite beliefs and values but tends to
overconcerned with the opinions of others.
3. 76-100 ( high differentiation)
Jelas nilai dan kepercayaan, goal directed, flexible,
secure, autonomous, can tolerate conflicts and
stress, well defined sense of solid self and less
pseudo self/ pretend self( Roberto, 1992)
2. Segi Tiga (Triangles) interlocking triangles

3. Sistem emosi keluarga asas ( Nuclear family emotional system)
4. Proses projeksi keluarga (Family projection process)
5. Emotional cut-off pengelakan untuk tidak berhubung, keluarga
yang anxieti
6. Proses transmisi pelbagai generasi ( multigenerational transmission
process)
7. Kedudukan adik-beradik ( sibling position- roles and function) e.g.
pasangan berkahwin adalah anak bongsu dalam keluarga terlalu
terbeban dengan tanggungjawab dan membuat keputusan
Anak sulong- bersaing
8. Societal Regression- tahap differentiation masyarakat rendah
lemah keputusan yang manasabah dan lebih kepada perasaan or
Band Aid solutions

Teknik:
Genogram
Going home again
Detriangulation
Person-to person Relationships
Differentiation of Self
Asking Questions

Aspek Unik:
1. Sejarah keluarga elak pengulangan
corak interaksi. Cont: Genogram

3. Jelas konsep dan intertwined.
2. Sistemik, berfokus dan amalan
menggunakan strategi kognitif.


Founder: Salvador Minuchin 1974
Latar belakang sebagai Child Psychiatry
Keluarga yang bermasalah ialah tiada struktur
organisasi dan tidak fleksibel dalam menghadapi

kitaran perkembangan keluarga.
Struktur keluarga yg baik- organisasi kemas dengan
mempunyai hierarki dan ahli mudah berhubungan.

Mudah dan cepat berfungsi kembali setelah
menghadapi tekanan, tekar, dan chaos. keseluruhan
wholeness


Tesis penting:
Simptom seseorang di fahami dengan
mengkaji corak interaksi dalam konteks

keluarga.
Perubahan dalam organisasi atau struktur
perlu diubah dahulu sebelum simptom
diubah.
Struktur keluarga mempunyai impak terhadap
perubahan terhadap individu.
Terapi keluarga Struktur

Pendekatan yang melihat keluarga sebagai satu
organisma yang mengalami perubahan.

Masalah keluarga berpusat kepada enmeshment
and disengagement, dengan keengganan untuk
berubah
Peranan terapi adalah aktif, intervensi terapi ialah
mencabar kewujudan "family reality." Strategi
membantu berfokus kepada joining dengan
keluarga dan restructure system


Konsep asas:
1. Struktur keluarga: Setiap keluarga mempunyai struktur dan
dapat dilihat apabila dilaksanakan.

Structure is an invisible set of functional demands by which
family members relate to each other( Minuchin, 1974).
- sebagai jumlah peraturan operasional yang berulang dan
konsisten.contoh: ayah mempunyai autoriti.
- bersifat tidak statik, komplementari (teamwork)
- ada struktur, hierarki, perbezaan di antara subsistem,


2. Subsistem Keluarga
Ciri- gender, generasi, minat, tugas
Subsistem pasangan, ibubapa, adik beradik,
- definisi: interpersonal boundaries dan
peraturan untuk ahli. Tentukan siapa dan apa

peranan dalam subsistem.
wujud kerana melaksanakan family task

.
3.Boundary Permeability
Boundaries how a family is organized. sempadan dalam
keluarga fleksibel ( permeability) dapat menentukan hubungan

bersama ahli keluarga.
Sempadan yang jelas (saya, kami, berada di tengah antara
enmeshment dan disengagement)
Sempadan yang tegar (diengagement)- kurang loyal, kurang
berhubung, tidak melindungi keluarga, kurang caring
Sempadan yang diffuse/berselerak ( enmeshement) terlalu
terlibat dan ambil tahu, eg. Children may act as parents,
parental control tak berkesan, excessive togetherness


5. Ketidakfungsian keluarga
- gagal melaksanakan tujuan membina keluarga yang
sihat (Colapinto, 1991).

- enmeshed families, disenggaged families, families
with a peripheral (dayus/ tidak berguna) male,
families with juvenile parents.
Perasan tertekan, tidak berdaya single parents

SIMBOL Peta Keluarga

Boundary Jelas
Boundary kabur
Boundary rigid/tegar
Terlibat
Sangat Terlibat
Konflik
Teknik:
Joining
Reframing
Unbalancing
Enactment
Working with spontaneous interaction
Boundary formation
Intensity
Restructuring
Shaping competence
Diagnosing.

Unik aspek
1.Versatility ( fleksibiliti) pelbagai jenis keluarga.
2. Nyah simtom dan menyusun semula organisasi
keluarga.
3. Pragmatik , penyelesai-masalah.
Kekurangan
- tidak sesuai untuk masalah yang kompleks.

Terapi Keluarga Strategik

Kenali juga sebagai brief therapy ( ambil masa yang
pendek)
Hasil kerja Milton Erickson Matlamat ialah
perubahan dengan menggunakan sumber milik klien
dan merekabentuk strategi for each specific
problem
4 jenis pendekatan:
a. The mental research institute (MRI)
b. The Family or Haley-Madanes, Institute
c. The Milan System Group
d. the Brief Therapy Center solution focused
Tokoh : Jay Haley, Paul Watzlawick, John Weakland,
Cloe Madenes.

Idea Jay Haley (1973)
Paling berpengaruh dalam terapi keluarga, mendapat didikan
dari Milton, BatesonGregory, dan Minuchin.

Tesis:
Terapi jangka pendek, 10 sesi.
Mempunyai ciri-ciri brief therapy
what need to be to be changed
Fokus kepada matlamat, masalah, bertujuan menjawab
sungutan klien.
Inervensi ialah mengubah organisasi keluarga agar presenting
problem atau simptom lenyap.
Perubahan keluarga tidak melalui celik akal tetapi melalui
proses arahan (directives) yang diminta oleh terpais.


In this approach, the therapist considers the therapy in
terms of step-by-step change in the way from one type

of abnormal organisation to another type before a more
normal organisation is finally achieved. For a strategic
therapist two questions are basic: How is the symptom
helping the family to maintain a balance or overcome
a crisis? How can the symptom be replaced by a more
effective solution of the problem?
Memfokuskan kepada mendefinisikan masalah
keluarga, menghubungkannya dan menyelesaikan

Developed strategies designed to outwit resistance and
provoke families into changing with or without their
cooperation
Peranan terapi ialah aktif dan interventif.

Memfokus kepada dimensi keluarga seperti:
Peraturan keluarga, homeostasis, quid pro
quo, prinsip redundancy, punctuation,

hubungan simetrikal dan komplementari,
sebebaban circular


Teknik:
1. Reframing
2. Directives
3. Paradox
4. Ordeals
5. Pretend
6. Positioning

Systemic
Systemic Family Therapy, atau Milan Model, memfokus pendekatan prescriptive
and paradoxical berdasarkan sistem teori. Mara Selvini-Palazolli and her

associates di Milan, Itali, mencipta keadah ini.
Fokus: mengalakkan keluarga melihat masalah dengan perspektif yang
berlainan dan bukan hanya mengubah tingkahlaku.
Milan Systemic Therapy (Boscolo et al, 1987)
Basic assumption of Milan Systemic Therapy is that mind is social. The
symptomatic behaviour is conceived as a part of the transactional
patterns of the system. Significance of any particular behaviour or event
may be derived from its social context. The therapists consider that the
way to eliminate the symptom which is present in the family is to change
the rules and beliefs. Change is achieved in clarifying the ambiguity in
relationships.
Menggunakan team interview with two members of the team conducting
the interview while other member, of the team observe from behind a twoway mirror.

Communications / Experimental
The work of Virginia Satir, and Carl Whitaker. These two pioneer family
therapists are unique and distinct.

Conjoint Family Therapy (Satir, 1967)
Conjoint family therapy works with personal experiences and helps
experiencing the value of the individual within the family system.
Therapists use all levels of communication to express the relational
qualities present in the family to achieve change in family system. This
approach uses many feeling and communication exercises and games,
for example family sculpture.
Masalah keluarga berpunca daripada tekanan perasaan, kurang
kesedaran, tidak ada perasaan (emotioanl deadness), penafian,
penggunaan mekanisma bela diri yang terlampau. mechanisms
Fokus: Komunikasi dalam keluarga dan menekankan rawatan yang
berbentuk experiential .

Matlamat terapi : fokus kepda sensitiviti dan
luahan perasaan , verbal dan nonverbal (role

play, mime (act out),

Behavioral, cognitive FT
Behavioral, cognitive, and affective common factors in MFT.
Behavioral regulation occurs in MFF when therapists facilitate

change in clients through, for example, changing interactional
patterns, modifying boundaries, changing family structures, and
helping clients to learn new skills. Cognitive mastery occurs in
MFT when therapists, for instance, help clients to gain insight
about interactional processes within themselves, the family,
between the family and other systems, and across generations
(Wampler, 1997). An example of affective regulation or
experiencing is when therapists facilitate the emotional
connections that clients make with themselves, the therapist,
and (most importantly) with each other.

Teknik Asas Terapi Keluarga

Genogram
The Family Floor Plan
Reframing
Tracking
Communication skill-building
Family Sculpting
Family photos
Special days, mini vacations, special outings
The Empty chair

Family Choreography (step designs ,lakunan)
Family Council meeting
Strategic Alliances
Prescribing Indecision
Putting the client in control of the symptom


Kuliah Model Terapi Keluarga

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Lima Model Terapi Keluarga

Terapi Keluarga Bowen

Fauziah Hanim Jalal Ph.D KKT 2013 Kaunseling

Masyarakat Malaysia tradisional

Fauziah Hanim Jalal Ph.D

bring about change in the family organization.

Fauziah Hanim Jalal Ph.D

Fauziah Hanim Jalal Ph.D

Centered Therapy (Rogers) both treated

Fauziah Hanim Jalal Ph.D

FAMILY VS. INDIVIDUAL

of understanding human behavior

Fauziah Hanim Jalal Ph.D

Therapy focuses on changing the family

FAMILY THERAPY PROCESS

others conduct little formal evaluation

Understanding Referral Source:

Divorce, Domestic Violence, Sexual Abuse, Affairs

Gender, Cultural Factors,

Assess to uncover issues, minefields Challenges, ethical issues

Fauziah Hanim Jalal Ph.D

Family Therapy Pie

Fauziah Hanim Jalal Ph.D

anxiety in all of life that comes with the

Fauziah Hanim Jalal Ph.D

Fauziah Hanim Jalal Ph.D

avoids conflict, lacks of capacity of autonomy.

2. Segi Tiga (Triangles) interlocking triangles

Fauziah Hanim Jalal Ph.D

Fauziah Hanim Jalal Ph.D

corak interaksi. Cont: Genogram

Fauziah Hanim Jalal Ph.D

Terapi Keluarga Struktur

organisasi dan tidak fleksibel dalam menghadapi

Struktur keluarga yg baik- organisasi kemas dengan

mempunyai hierarki dan ahli mudah berhubungan.

Fauziah Hanim Jalal Ph.D

Terapi Keluarga Struktur

mengkaji corak interaksi dalam konteks

Terapi keluarga Struktur

organisma yang mengalami perubahan.

Fauziah Hanim Jalal Ph.D

Terapi Keluarga Struktur

dapat dilihat apabila dilaksanakan.

Fauziah Hanim Jalal Ph.D

Terapi Keluarga Struktur

peraturan untuk ahli. Tentukan siapa dan apa

Terapi Keluarga Struktur

keluarga fleksibel ( permeability) dapat menentukan hubungan

Fauziah Hanim Jalal Ph.D

Terapi Keluarga Struktur

sihat (Colapinto, 1991).

Fauziah Hanim Jalal Ph.D

SIMBOL Peta Keluarga

Terapi Keluarga Struktur

Terapi Keluarga Struktur

Fauziah Hanim Jalal Ph.D

Terapi Keluarga Strategik

Terapi Keluarga Strategik

dari Milton, BatesonGregory, dan Minuchin.

Fauziah Hanim Jalal Ph.D

Terapi Keluarga Strategik

terms of step-by-step change in the way from one type