Family Therapy

• A system is an organized assemblage of parts forming a complex whole.
• Bateson found systems to be a perfect vehicle for illuminating theways in which families functioned as units.

Family homeostasis (self/family regulation that keeps in balance)--dysfuncational families tendency is to resist change-- explains why somany patients remain stuck.

• General systems theory- a biological model of living systems as entities that maintain themselves through continuous input and output from the environment, developed by Ludwis von Bertalanffy
• *Can also be defined as any entity maintained by the mutual interactive of its parts...A system can be composed of smaller systems and can also be part of a larger system, just as a state or province is composed of smaller jurisdictions and also is part of a nation.

• Every system is a subsystem of larger systems.
• Main component of general systems theory is to FOCUS ON INTERACTIONS RATHER THAN PERSONALITIES.

An open system is continuously interacting with it's environment. Dueto equifinality --ability to read a final goal in a variety of ways-- there is never only way way to achieve families objectives.

Rather than overemphasis on homeostasis, families are more aptly described as complex adaptive systems ((open and susceptible to significant changes in the nature of the components themselves)) with important consequences for the system as a whole.

• -->makes self regulation and self direction possible
• -->modify structure and evolve--morphogenesis <<plastic quality of adaptive systems>>

• Summarizing:
• Issues that shape family therapy
• *A system as more than the sum of its parts
• *Emphasis on interaction within and among systems vs reductionism
• *Human systems as ecological organisms vs mechanism
• *Concept of equifinality
• *Homeostatic reactivity vs. spontaneous activity

• Second Order Change:
• defined as Basic change in the structure and functioning of the system as opposed to first order change:
• First order change is when a specific behavior changes within the system.
• Second order change is when the rules of the entire system change.

Intrapsychic thinking has to do with the interpersonal processes of the individual... this differs from systems theory thinking because the intrapsychic thinking is just one piece in the whole system of the family.

• Diversity and Ethnicity
• *Family as system within larger system of community, culture and politics.

• In Healthy families:
• *Success is measured by differentiation of self.
• *Family is a place of sharing experience
• *Family encourages authenticity.*Communication is direct and honest.
• *Differences are faced rather than hidden.
• *Have the ability to talk about problems

• Other stuff:
• Structural hierarchy- lines of authority clearly drawn.
• Desire for differentiation.
• Seek help at transitional stages.
• Flexible Structures, clear boundaries.
• Well organized hierarchies and they use positive reinforcement control, offer secure attachment and provide mutual need satisfactions.

• 'Narrative therapists' goal is to externalize problems within thefamily - instead of having a problem or being a problem, clients are encouraged to think
• of themselves as struggling against the problem.
• *Conflict resolutions (parents appreciate children, accept feelings and validate experience).
• *Mother and father discuss behaviors of concern *Effective coping behavior- Healthy attachment- *Healthy family offers freedom to be oneself.

• Attunement, attachment, empathy, and dependency *Support for feelings and creative impulses.
• *Parents must be accomodating to boundary making

“Coping is the outcome of self worth, rules of the family systems, and links to the outside world.” – Satir

In a family system people develop complimentary coping stances in order to get by/along or survive (i.e. a placating stance can compliment a super responsible stance).

• The problem is manageable if approached in a congruent manner. If approached in an incongruent manner, the problem stimulates coping behaviors that are harmful to family members. They may deny themselves, others or the context. Families can learn to communicate from a congruent stance where each person honors the self, the other, and the context.
• Any small change in any one member can create change in the other members (the whole system).

• Change can come from an internal shift that
• creates an external change.

Staus quo is challenged by a new stimulus that creates chaos which is integrated then practiced for a new status quo.

• Three parts to honor for congruence: \
• Self
• Other
• Context (the pie chart)

• Congruence (hands extended, palms up) represents effective communication that comes from a
• place of respect and acceptance of the self and of other people.
• Members act from high self-esteem. Family members connect through similarities and grow through their differences.
• Members can tolerate mistakes, and have flexible rules.

Coping stances – each denies self, other and/or context.

• *Placating (on knees)
• Self is denied, take the blame for things that go wrong, rush to rectify trouble.
• Other is honored more than self. Context is honored.
• Wisdom aspect is caring and sensitivity.

• *Blaming (finger pointing)
• Self is hostile or violent, refuses suggestions and disagrees.
• Covers low Self-esteem with blame. Other is discounted and denied.
• Context can be fought through, can stand up for the self in context, does not accept excuses or abuse from anyone.
• Wisdom aspect is assertiveness.

• *Super Responsible (arms folded)
• Self is denied and not allowed to feel
• Isolated from context.
• Rational.
• Must be intelligent and right.
• Other is denied.
• Context is referred to in a functional way (i.e. Refers to rules and what is right)
• Wisdom aspect is intelligence.

• *Irrelevant (head down, bent at waist) Self distracts attention from issues, Other does not matter.
• Will not focus on other.
• Context does not matter.
• Will focus on other subjects.
• Wisdom aspect is fun, spontaneity and creativity.

The functioning of family members may repeat itself across several generations. In such cases, a particular style of functioning (whether adaptive or maladaptive) or of dealing with problems is passed down from one generation to the next. This transmission does not necessarily occur in linear fashion.

Numerous symptomatic patterns such as alcoholism, incest, physical symptoms, violence, and suicide, tend to be repeated in families from generation to generation. By noting the pattern repetition, the clinician may be helped to understand the family's present adaptation to the situation and to short circuit the process.

Other examples of multigenerational patterns can include degree of religion, type of religion, type of work/career, age of marriage, age of starting a family (teenage pregnancy), interest and skills in the arts (music, art, etc.), military affiliation, computer savvy, political leanings and involvement, community involvement, outdoor/sports orientation, athleticism, and more.

Key to understanding this multigenerational patterns is that in previous generations, certain behaviors and coping mechanisms have been modeled. There mere fact that they happened is re-enforcement that the coping mechanism is an option and may be considered.

The opposite may also happen. One generation may use a coping mechanism, and the next generation is so put off by that coping mechanism (such as drinking) that they will avoid it to an extreme perhaps leading to an every other generational pattern.

Add in your own experience regarding your own family system and the pattern that seems strongest to you and how that pattern has influenced your life.

• Strengths:
• I come from a relatively healthy family.
• Weakness:
• I come from a relatively healthy family.

Fear of working with a family is that I won't understand their perspective, the culture or ethnicity and therefore will have the ability to help.

An excitement in potentially working with families is the ability to specialize in some specific problems and that I am allowed a learning curve.

The biggest countertransference issue that scares me is getting angry and judgmental at any member of a family for behaving in a way that I see as destructive, deliberate, mean. It's a very uninformed approach and I'm afraid it will affect the field to such a degree that it won't be helpful at all in the exchange.

• Other answers:
• Countertransference:
• <<emotional reactivity on part of therapist>>- I have
• difficultly with passive aggressiveness and controlling patterns. If a male figure is over controlling of a female within the family, or overly domineering, I could see myself ‘siding’ with the female. Also, issues of condescension. Conflict avoidant families may be triggering as well because most of my family is conflict avoidant and it seems very unhealthy to me. Might have a desire to solve marital problems and keep the family together and at peace- also might want to ease tension, conflict and anxiety which may manifest in many ways.

• “individual is just a product of the family”- ability to cope with and adapt to change
• Weaknesses/fears:
• desire to want to fix problems, or solve situations or analyze ‘correctly’.
• Also possible induction into content of family issues
• rather than focusing on interactions and process.

• *The family is the expert on their own system.
• *Look for the wisdom in the system.
• *How is the system working for the family?
• *Learn about the ethnicity and structure of the family, from the family themselves and also from other sources (talk to people of that ethnicity or who are from similar structures, read books and articles about the ethnicity and family structure) but remember that they are experts about their own family.

• Assumptions/ or important things to consider when considering family therapy:
• *Is it logical and feasible for the whole family to meet together?
• *Are the problems of the IP symptoms of the family? *How does the family view the IP?
• *Symptoms and problems are tied to one another in powerful and reciprocal ways?
• *Interconnected?
• *Is the therapist role to modify relationships or improve communication?
• *Most important aspect of working with different cultures is to remain curious and open.
• *Stereotypes and 'multicultural' education are guidelines.
• *Know where your level of expertise is.

• In class, we looked at six concepts. The book lists 8. The sourcebook has quite a few more. I will trace the
• ones from the book, which are also the ones from class.

• Differentiation of self
• -this is the cornerstone of Bowen’s theory.
• Intrapsychically this means the ability to separate
• feelings from thoughts.
• Interpersonally this means the ability to
• differentiate yourself from others.
• To be differentiated means to be capable of strong emotion and spontaneity but also capable of restraint
• and objectivity-not completely ruled by emotions. It also means you can take strong stands on issues without being shaped by others' viewpoints. Differentiation can also be the process of partially freeing oneself from the emotional chaos of one’s family. Not blaming everyone but yourself.

• Triangles-
• Virtually all emotionally significant relationships are shadowed by third parties-relatives, friends, even memories. When two people feel distant this is when triangles usually develop. Whenever we hear a
• story in which one person is victim and one a villain, we’re being invited into a triangle. Triangulation lets off steam but it freezes conflict in space.

• Nuclear family emotional process-
• also known as undifferentiated family ego mass, it’s the emotional forces in families that operate over the years in recurrent patterns. The less differentiation of self prior to marriage-which leads to emotional cutoff
• from parents, the greater the fusion between spouses, which can produce:

• 1) reactive emotional distance between spouses,
• 2) physical or emotional dysfunction in one spouse,
• 3) overt marital conflict or
• 4) projection of a problem onto children.

• Family projection process-
• Parents transmit their immaturity and lack of differentiation to children, often as an intense focus on one or more of the children. The child who is the object of this projection becomes most attached and unable to differentiate.

As the parent focuses his/her anxiety on the child, the child’s functioning is stunted, which leads to more attention and the cycle goes on.

• Multigenerational transmission process-
• The transmission of the family emotional process through multiple generations. The child most involved in the family’s fusion has a low level of differentiation while the least involved child moves toward higher differentiation, continuing through the generations.

• Sibling position-
• Children develop certain fixed personality characteristics based on the sibling position in their families.

• Emotional cutoff-
• the way people manage undifferentiation between the generations. The greater the emotional fusion between generations the more likelihood of cutoff. Sometimes mistaken for emotional maturity because it looks like independence from family, but it hides the actual response to the family, which is intense
• and troubled.

• Societal emotional process-
• how the emotional process in society influences the emotional process in families.

• Four examples from my own family system
• Differentiation-This is a little tied in to emotional cutoff for me as well, but there was a feeling growing up that I had a good-enough mother, in which I felt
• space to explore on my own while also feeling loved. This allowed me to branch out on my own and follow my own ideas and have something of a balance between my emotions and my thoughts. I say emotional cutoff because there is also a way in this that I just moved away and didn’t deal with things
• completely with the family. I more or less feel freed from the emotional chaos of my family.

• Triangles-
• My mother has often been irritated with my father for bringing her to Ohio. This put distance between them and both have come to me to confide their feelings about the situation.

• Sibling position-
• I was a middle born child and because I struggled to find a nichein my family I have been something of a searcher most of my life, moving all around, trying new things. I also have a certain stability, became family listener, less self indulgent than younger brother, less motivated than older brother. Invisible at times.

• Emotional cutoff-
• This has gotten better but when I used to arrive home, I would become ill from anxiety or have extreme
• anger explosions, but living far away always feeling like the relationship was good.

The first concept is Differentiation of Self, or the ability to separate feelings and thoughts.

• Undifferentiated people can not separate feelings and thoughts;
• When asked to think, they are flooded with feelings, and have difficulty thinking logically and basing their responses on that. Further, they have difficulty separating their own from other's feelings; they look to family to define how they think about issues, feel about people, and interpret their experiences.



Differentiation is the process of freeing yourself from your family's processes to define yourself.

• This means being able to have different opinions and
• values than your family members, but being able to stay emotionally connected to them. It means being able to calmly reflect on a conflicted interaction afterward, realizing your own role in it, and then choosing a different response for the future.

Congruence refers to the therapist's openness and genuineness—the willingness to relate to clients without hiding behind a professional facade.

• Therapists who function in this way have all their feelings available to them in therapy sessions and may share significant emotional reactions with
• their clients.

Congruence does not mean, however, that therapists disclose their own personal problems to clients in therapy sessions or shift the focus of therapy to themselves in any other way.

• Read more:
• Person-centered therapy - children, people, used, personality, theory, Definition, Purpose, Description, Normal results.

http://www.minddisorders.com/Ob-Ps/Person-centered-therapy.html#ixzz1f1LqZlN8

• Differentiation allows for a family to be made up of its true members, all free to be who they are and express what they need to, creating a healthier family
• unit.

• Solution Focused Therapy (SFT) is sometimes linked to general Brief Therapy, Problem-Focused Therapy,
• and Possibility Therapy…. All share some common points of focus:
• • Traditional therapy goes wrong by focusing on the cause of problems, the details of how they play out, the ways these events deviate from "normal" or the way couples are "supposed" to work, and having couples passively accept the expert therapists' explanations of "what is wrong" with them. Doing this gets clients stuck in a passive and helpless role, locked into a problem narrative they rehearse over
• and over again
• • A better approach moves client focus off of what's wrong and onto what's right, stresses the resources and skills clients have, and helps them
• take the role of expert (which they hold anyway) and take responsibilityfrom there for setting their own goals and reaching them. It's not about what's missing and causes woe, but what's present and can lead to happiness
• • Solution building is the goal, and as you change the language that shapes how you think about the problem, you change the language that shapes how you think about the solution.
• • There is no theory behind this, and you need not fully understand the problem to fix it. The solution may not even look like it will fit or resolve the problem, and that's fine - a small enough change will nudge the system in a different direction and that may be all that's needed
• • Therapists maintain a future focus, with language like "when this is fixed…" "notice when this problem doesn't happen this week…" "write down what your partner does to fix the problem this week…"
• • Rather than summing up what the therapist thinks the clients is saying, the therapist asks questions to focus and direct the client's thinking and view.

• Looking for exceptions
• Even when a client does not have a previous solution that can be repeated, most have recent examples of exceptions to their problem. These are times when a problem could occur, but does not. The difference between a previous solution and an exception is small, but significant. A previous solution is something that the family has tried on their own
• that has worked, but later discontinued.

An exception is something that happens instead of the problem, often spontaneously and without conscious intention.

• SF therapists may help clients identify these
• exceptions by asking, “What is different about the times when this is less of a problem?

”Present and future-focused questions vs. past-oriented focus

The questions asked by SF therapists are usually focused on the present or on the future. This reflects the basic belief that problems are best solved by focusing on what is already working, and how a client would like their life to be, rather than focusing on the past and the origin of problems. For example, they may ask, “What will you be doing in the next week that would indicate to you that you are continuing to make progress?”

• Compliments
• Compliments are another essential part of solution focused brief therapy.

• Validating what clients are already doing well, and acknowledging how difficult their problems are encourages the client to change while giving the message that the therapist has been listening (i.e.,
• understands) and cares. Compliments in therapy sessions can help to punctuate what the client is doing that is working.

In SF therapy, compliments are often conveyed in the form of appreciatively toned questions of “How did you do that?” that invite the client to self-compliment by virtue of answering the question. Inviting the clients to do more of what is working. Once SF therapists have created a positive frame via compliments and then discovered some previous solutions and exceptions to the problem, they gently invite the client to do more of what has previously worked, or to try changes they have brought up which they would like to try – frequently called “an experiment.

• "Miracle Question (MQ)
• This unusual sounding tool is a powerful in generating the first small steps of 'solution states' by helping clients to describe small, realistic, and doable steps they can take as soon as the next day. The miracle question developed out of desperation with a suicidal woman with an alcoholic husband and four “wild” children who gave her nothing but grief. She was desperate for a solution, but that she might need a
• 'miracle' to get her life in order. Since the development of this technique, the MQ has been tested numerous times in many different
• cultures.

• Coping Questions
• This question is a powerful reminder that all clients engage in many useful things even in times of overwhelming difficulties. Even in the midst of despair, many clients do manage to get out of bed, get dressed, feed their children, and do many other things that require major effort.

• Coping questions such as “How have you managed to carry on?” or “How have you managed to prevent things from becoming worse?” open up a different way of looking at client’s resiliency and determination. _______________________________________
• Structural Family Therapy (SFT) is a method of psychotherapy developed by Salvador Minuchin which addresses problems in functioning within a family. Structural Family Therapists strive to enter, or "join", the family system in therapy in order to understand the invisible rules which govern its functioning, map the relationships between family members or between subsets of the family, and ultimately disrupt dysfunctional relationships
• within the family, causing it to stabilize into healthier patterns.
• [1] Minuchin contends that pathology rests not in the individual, but within the family system. SFT utilizes, not only a unique systems terminology, but also a means of depicting key family parameters diagrammatically. Its focus is on the structure of the family, including its various substructures. In this regard, Minuchin is a follower of systems and communication theory, since his structures are defined by transactions among interrelated systems within the family. He subscribes to the systems notions of wholeness and equifinality,
• both of which are critical to his notion of change. An essential trait of SFT is that the therapist actually enters, or "joins", with the family system as a catalyst for positive change. Joining with a family is a goal of the therapist early on in his or her therapeutic
• relationship with the family.

• Therapeutic Goals and Techniques
• Minuchin’s goal is to promote a restructuring of the family system along more healthy lines, which he does by entering the various family subsystems,
• "continually causing upheavals by intervening in ways that will produce unstable situations which require change and the restructuring of family
• organization... Therapeutic change cannot occur unless some pre-existing frames of reference are modified, flexibility introduced and new ways of functioning developed." To accelerate such change,
• Minuchin manipulates the format of the therapy sessions, structuring desired subsystems by isolating them from the remainder of the family, either by the use of space and positioning (seating) within the room, or by having non-members of the desired substructure leave the room (but stay involved by viewing from behind a one-way mirror). The aim of such interventions is often to cause the unbalancing of the family system, inorder to help them to see the dysfunctional patterns and remain open to restructuring. He believes that change must be gradual and taken in digestible steps for it to be useful and lasting. Because structures tend to self-perpetuate, especially when there is positive feedback, Minuchin asserts that therapeutic change is likely to be maintained beyond the limits of the therapy session.

• One variant or extension of his methodology can be said to move from manipulation of experience toward fostering understanding. When working with families who are not introspective and are oriented toward concrete thinking, Minuchin will use the subsystem isolation—one-way mirror technique to teach those family members on the viewing side of the mirror to move from being an enmeshed participant to being an evaluation observer. He does this by joining them in the viewing room and pointing out the patterns of transaction occurring on the other side of the mirror. While Minuchin doesn’t formally integrate this extension into his view of therapeutic change, it seems that he is requiring a minimal level of insight or understanding for his subsystem restructuring
• efforts to "take" and to allow for the resultant positive feedback among the subsystems to induce stability and resistance to change. Change, then, occurs in the subsystem level and is the result of manipulations
• by the therapist of the existing subsystems, and is maintained by its greater functionality and resulting changed frames of reference and positive feedback.

The therapist changes roles throughout therapy and operates on mulitple levels; awareness of the present moment is most important.

• The therapist's role is divided into 3 phases:
• Phase 1: Joins the family and takes leadership--takes on style of communication
• Phase 2: -Mentally maps underlying family structure
• -Assesses developmental stage, evaluates
• system's flexibility and ability to restructure
• Phase 3: Helps transform structure-flexible, clear
• boundaries & rules, durable/sustainable

The three essential components in the conceptual framework of Structural Family Therapy are 1) structure, 2) subsystems, 3) and boundaries.

Family structure refers to the way a family is organized into subsystems and how the interaction among those subsystems is regulated by boundaries.

The process of a family's interaction is like the patterns of conversation at the dinner table.

The structure of the family is like where family members sit in relation to one another. Who sits next to who makes it easier to interact with some people and less so with others.

Keep in mind that structure is reinforced by the expectations of each individual about someone else's behavior. "He'll probably..." or "Family members should always look out for one another." Are there patterns of behavior like one person getting stuck with a certain chore or most of the work? Family transactions are repeated.

THE GOAL OF STRUCTURAL THERAPY IS STRUCTURAL CHANGE, PROBLEM SOLVING IS A BY-PRODUCT

• Where/how do issues/ problems arise in family systems? They arise when external pressures, like finals week, or developmental transitions, like
• launching kids, meet w/boundaries that are too rigid or diffuse and there is a failure to mobilize support.

Megan added: “Problems occur as the result of ongoing patterns of communication within the family (from “An Introduction to Family Social Work”). Problems also arise when boundaries are too strong or too week.

• According to Minichin, boundaries vary from diffuse to rigid. What are the three essential components in the conceptual framework of this school of therapy? 1) Structure (the organized pattern in which families
• interact) What our family has learned to do when certain things happen. (Kid spills milk, all cringe because parents throw fits.)
• 2) Subsystems. May be organized by generation, gender, function.
• 3) Boundaries. Invisible barriers regulating contact. (No TV, texting, or phone calls at the table.)

Issues with addiction are created through a combination of genetics and environment. Dysfunctional early childhood relationships are a common contribution for addictions.

Bowlby developed attachment theory.

• “How responsive a caretaker is to a child’s needs throughout the infant and toddler stages had implications for the development of the child and
• his/her relationships throughout life”.

• Attachment styles –
• Secure, anxious, avoidant, Disorganized. “ The more secure the child is in their primary relationship, the healthier he/she will be physically, cognitively, emotionally, spiritually, and socially”.

• These patterns of attachment behavior are often repeated generation after generation. Triangulation patterns of family behaviors also perpetuate the
• addiction cycle. In a therapeutic environment, addiction may be viewed through the lens of
• attachment theory. If we see addiction as a person’s primary attachment, we can help the client understand that relationship, grieve it and seek healthier attachments. We can conceptualize cravings for a
• substance or a behavior as longings for connections, and we can work with the client to replace the addiction with healthy connections to others…
• the therapeutic relationship can be conceptualized as an attachment relationship.

• Attachment styles appear to be passed down from
• generation to generation. Therapists might want to assess the parenting styles of clients as well as their parents. This can assist both in planning therapeutic strategies for clients and in preventing unhealthy
• attachment experiences from being repeated. There
• is no easy fix to addiction. Successful long-term recovery addresses the systemic family patterns of behavior (samsara) as well as addresses
• the spiritual, psychological, social, physical, and biological consequences addiction has on a client/person’s live. Systemically, if a client changes their addiction patterns to more healthy attachments,
• this will create change within the family. The most successful recovery provides a path for everyone to heal—not just the addicted individual.