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The family systems perspective
- Individuals– are best understood through assessing the interactions within an entire family.
- Family: a social system which supports the survival, stability and welfare of its members. It is more than the sum of its parts.
- A systems orientation does not preclude dealing with
- the dynamics within the individual, but this approach broadens the traditional emphasis on individual internal dynamics and looks at group dynamics
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View of symptoms
- Symptoms are viewed as an expression of a dysfunction within a family.
- eg. not communicating well, fighting all the time
- When change occurs, a ripple effect flows through the family system.
- Problematic behaviors:
- – Serve a purpose for the family
- – Are unintentionally maintained by family processes
- – Are a function of the family’s inability to operate productively
- – Are symptomatic patterns handed down across generations
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Differences between systemic and individual approaches
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Contributions of the family systems approach
- In most systemic approaches, neither the individual nor the family is blamed for a particular dysfunction.
- An advantage to this approach is that an individual is not scapegoated as the “bad person” in the family although the family may have scapegoated one of the family members. This individual may be the reason that the family enter therapy.
- The family is empowered through the process of identifying and exploring internal, developmental, and purposeful interactional patterns
- Developmental: eg expecting older childern to look after younger ones
- Or not giving kids any responsibility
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Limitations of the family systems approach
- An overemphasis on the system may result in the unique characteristics of individual family members being overlooked.
- The individual may need personal therapy as well as benefit from family therapy.
- Concern with the well-being and function of the system may overshadow the therapist’s view of the needs and functioning of individuals in the system.
- Practitioners must not assume that Western models of family are universal and must be culturally competent
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Adlerian Family Therapy
- Developed by Alfred Adler, this approach is based on an educational model and birth order. In particular, the child’s interpretations of their birth positions. An older adult may act as miniature adults.
- Emphasis is on family atmosphere and family constellation (family system).
- Therapists function as collaborators who seek to join the family.
- Assessment includes parent interviews which yield hunches about the purposes underlying children’s misbehavior.
- All behaviour serves a purpose.
- Adlerians believes that children act in a pattern motivated by a desire to belong.
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Treatment goals of AFT
- Assessment of the family involves family members describing daily interactions and their roles in the family constellation.
- Assessment aims to unlock behavioural and interactional patterns.
- Engage parents in a learning experience and a collaborative assessment – i.e., their role in the repetitive and negative interactions. “What do you think you are doing here?”
- Emphasis is on the family’s motivational patterns – What is the problematic behaviour aiming to achieve? What do others do when I behave this way?
- Main aim is to initiate a reorientation of the family
Reorientation: seeing things from other perspectives
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Multigenerational family therapy
- A theoretical and clinical model developed by Murray Bowen that evolved from psychoanalytic principles and practices
- – Problems in one’s family need to be understood by considering one’s family of origin and their patterns of behaviour and these patterns directly challenged.
- The family is viewed as an emotional unit – Who pushes your buttons? How did they do it? What were the issues involved?
- Within the family unit, unresolved emotional reactivity to one’s family unit are considered (those who push your buttons).
- Family of origin issues must be addressed if one hopes to achieve a mature and unique personality.
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Multigenerational family therapy- triangulation, differentiation of the self
- Triangulation: A third party (the therapist) is recruited to reduce anxiety and stabilize a couples’ relationship.
- Differentiation of the self: A psychological separation from others – separation of intellect and emotion and independence of the self – as in the process of individuation and development of self and the opposite of a state of emotional reactivity. Being calm under duress – the observer role. (observe emotions, calm, strong core sense, wise self, detached self)
Role therapist is to model observer role to create within themselves
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MFT treatment goals
- To change the individuals within the context of the system
- To end generation-to-generation transmission of problems by resolving difficult emotional attachments
- ▪ To lessen anxiety and relieve symptoms
- ▪ To increase the individual member’s level of differentiation or self-identity
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Human validation process model
- Virginia Satir's model of family therapy.
- Enhancement and validation of self-esteem .
- Family rules
- Congruence – emotional honesty, openness and congruence in communications
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Satir's conceptual framework
- 1. Our family of origin, including past generations, has a significant influence on our attitudes and behaviours.
- 2. Families are systems and as such seek balance; when that balance is maintained through inappropriate roles, restrictive rules, and/or unrealistic expectations, the members’ needs will not be met, and dysfunction will occur.
- 3. The result of dysfunctional family systems is low self-esteem and defensive behaviour, as the basic drive of human beings is to enhance self-esteem and defend against threats to it.
- 4. Each person contains all the resources one needs for growth and healthy functioning.
- 5. The therapist and his or her beliefs are the most important tools at his or her command.
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Human validation process model key strategies
Key strategies of Virginia Satir’s model of family therapy include:
- Sculpting: family members design their relationship & dynamics to one another using posture, facial and other gestures to create distance or closeness to one another. (moving people around to reflect what's going on)
- Nurturing triads: establishing trust and gaining acceptance of the family.
- Family mapping (family of origin) and Family-Life chronologies (what happened to you as you developed).
- New Communication patterns and healthier ways of coping.
- Reframing: the problem behaviours are redefined.
Psychodrama
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Goals of Satir's HVPM
- Open communication:
- – Individuals are allowed to honestly report their perceptions
- – Reduce communication stances used in times of stress.
- – The four communication stances are blaming, placating, super reasonable and irrelevance and aim to hide one’s feelings from oneself and others.
- ▪ 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
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The four communication stances (ie roles)
- Blaming: Shift responsibility to someone else.
- Placating: Taking the blame to protect someone else from being held responsible.
- Super Reasonable: Responding to a situation with facts and maintaining emotional control.
- Irrelevance: Using distracting communication to avoid the situation.
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Experiential family therapy
- Carl Whitaker
- A freewheeling, intuitive approach that aims to unmask pretense, create new meaning, and liberate family members to be themselves.
- Whitaker stressed choice, freedom, self-determination, growth and actualisation and used co-therapists. Methods were secondary in treatment.
- Techniques are secondary to the therapeutic relationship. As a therapist, intuition is important as an approach.
- The relationship between family and therapist was considered of primary importance.
- Pragmatic and atheoretical – more confrontational in approach.
- Interventions create turmoil and intensify what is going on in the family as a motivation for change
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Goals of EFT
- 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” – Models the therapist approach.
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Structural family therapy
- Salvador Minuchin
- This approach focuses on family interactions to understand the hierarchies (where the power lies), boundaries and structure, or organization of the family.
- Symptoms are a by-product of structural failings. Mental health problems are a sign of dysfunctional family.
- Structural changes must occur in a family before an individual’ s symptoms can be reduced.
- Techniques are active, directive, and well thought-out.
- Therapist is an active member of the treatment group.
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Treatment goals of structural family therapy
- Reduce symptoms of dysfunction and bring about structural change by:
- – Modifying the family’s transactional rules
- – Developing more appropriate boundaries
- – Creating an effective hierarchical structure
- – The goal of SFT is to improve communications and interactions among family members and to highlight appropriate boundaries to create a healthier family structure.
- – Role Play in session
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Strategic family therapy
- Jay Haley
- Often used in combination with Structural Family Therapy.
- Presenting problems are accepted as “real” and not a symptom of system dysfunction.
- Therapy is brief, process-focused, and solution-oriented.
- Change results when the family follows the therapist’s directions and change transaction
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Treatment goals of strategic family therapy
- 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
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Interventions Used by Structural-Strategic
Therapists
- Joining: Strategic use of establishing rapport – careful listening.
- Unbalancing: Therapist may take sides with a partner during treatment.
- Reframing: redefining a problem scenario
- Boundary Setting and testing boundaries: Who participates and how?
- Ordeals: A task to one or more family members that requires them to do something they do not want to do but would benefit from in reducing symptoms.
- Paradoxical interventions: (for example, suggesting the family take action seemingly in opposition to their therapeutic goals)
- Enactments: or role play
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Recent Innovations in Family Therapy
- In recent times, feminism, multiculturalism, and postmodern social constructionism have all entered the family therapy field. These models are collaborative, treating clients as experts in their own lives.
- These new approaches challenge first-order cybernetics – the view that counsellor and therapist as an observer outside of the system – the traditional medical model. The therapist is active and aids the client in taking a stand in relation to the dominant culture that may be oppressing them.
- Feminist and postmodern models of family therapy are based on the perspective of second-order cybernetics – the family practitioner becomes part of the system and by being present with the family, changes it.
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A Multilayered Process of Family Therapy
- Families are multilayered systems that both affect and are affected by the larger systems in which they are embedded.
- Both the members and the system can be assessed based on power, alignment, organization and structure, development, culture, and gender
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Strengths From a Diversity Perspective
- Many ethnic and cultural groups place great value on the extended family.
- ▪ Monica McGoldrick has been the most influential leader in the development of gender and cultural perspectives and frameworks in family practice.
- Family therapists explore the individual culture of the family, the larger cultures to which the family members belong, and the host culture that dominates the family’s life
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Limitations From a Diversity Perspective
- The process of differentiation occurs in most cultures, but it takes on a different shape due to cultural norms.
- A possible shortcoming of the practice of family therapy involves practitioners who assume Western models of family are universal.
- Some family therapists focus primarily on the nuclear family, which is based on Western notions, and this could be a shortcoming in working with clients in extended families
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Genograms
- Square: male
- Circle: female
- Divorced: dotted sideways
- Cross: death
- Miscarriage: straight line to black dot
- Adoption: straight line parallel to dotted line
- Gay: upside down triangle in a square/circle
- Distant relationship: dotted line
- Conflict: /\/\/\/\/
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Group Therapy – Why are groups important
- Provide the structure upon which families, communities and societies are built
- ▪ Enable relationships to occur
- ▪ Provide connection with others
- ▪ Facilitate learning of social norms, form identity & achieve personal goals
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Group Dynamics
- Patterns of interactions that develop within groups over time
- ▪ How members behave in the group
- ▪ How people think & feel in the group
- ▪ The continuing responses & changes that occur
- ▪ With positive group dynamics: The group’s purpose is achieved. Individual members’ socio-emotional needs are met.
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Group Dynamics which can be Observed
- Resistance eg silence, argumentative, lateness…
- ▪ Conflict eg against leader, against another member
- ▪ Cohesion eg developing a sense of ‘we’re in this together’
- ▪ Unhelpful behaviours identified eg attention seeking, splitting…
- ▪ Emergence of task/work focus
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Interaction patterns
- Communication
- ▪ verbal & non-verbal
- ▪ who speaks to whom?
- ▪ who is silent, who speaks?
- ▪ who listens?
- ▪ who is disengaged, bored…?
- ▪ who encourages others, is enthusiastic?
- Group cohesion
- Group culture: values, beliefs, traditions, rules…
- Facilitator’s role
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How can these patterns be influenced?
- Leadership/facilitation: is there a difference?
- Importance of leadership in developing and maintaining a group
- Group leadership:
- ▪ skills
- ▪ knowledge
- ▪ emotional resources: care, empathy
- ▪ personality
- ▪ ideas, vision, imagination
- ▪ style of interaction: depends on nature of group; positive or damaging?
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Yalom and group psychotherapy
- The Therapeutic Factors
- Installation of Hope: Faith in the treatment method can be therapeutically effective
- Universality: Most clients think they are alone or unique in their problems
- Imparting Information: Psycho-education and direct advice
- Altruism: Clients receive through giving as part of the reciprocal giving-receiving sequence. Helping others has given me more self-respect
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Yalom and group psychotherapy part 2
- The corrective recapitulation of the primary family group most who enter groups have a background of stress from their family of origin or primary family. Group Therapy resembles a family. “This group is like my family.”
- Development of socialising techniques: Social learning which may be explicit. E.g. a group for Asperger’s. In other groups it is indirect.
- Imitative behaviour: Modelling of behaviours. Effective in a group for Asperger’s Syndrome
- Interpersonal Learning: The Group as a Social Microcosm
- Group Cohesiveness: Belonging and acceptance by others
- Catharsis: An opportunity to vent negative and positive feelings about the group leader or other members
- Existential Factors: “Life is not fair.” “Taking responsibility for my decisions."
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Yalom’s Principles of Group Psychotherapy applied to an ante-natal group of first-time mothers
- Recognizing the importance of interpersonal relationships and viewing the group as a social microcosm. The members of the group can provide a tremendous amount of support, reassurance, insight and constructive feed-back to each other. The support and responses provided to each other can also have ramifications for the women’s daily lives, extending beyond the weekly sessions and to a support group that can continue post-natally.
- The women enter a support group where they meet other women who are experiencing the same complexities of becoming a first-time mother. The women can feel that they are not alone with their problems, anxieties and concerns. They share similar problems with one another.
- The specialized nature of the group (of first-time mothers) allows for the imparting of information by the facilitator relevant to the needs and concerns of the women
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Murray Bowen
- believed families could best be understood when analyzed from a three-generation perspective.
- Two of his objectives in therapy were to help family members develop a rational, nonreactive approach to living (differentiation of self) and to de-tangle family interactions that involved two people pulling a third person into the couple’s problems and arguments (or triangulation).
- He contended that problems manifested in one’s current family will not significantly change until relationship patterns in one’s family of origin are understood and directly challenged.
- His approach operates on the premise that a predictable pattern of interpersonal relationships connects the functioning of family members across generations.
- His family systems theory, which is a theoretical and clinical model that evolved from psychoanalytic principles and practices, is sometimes referred to as multigenerational family therapy.
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Virginia Satir
- developed conjoint family therapy, a human validation process model that emphasizes communication and emotional experiencing.
- Like Bowen, she used an intergenerational model, but she worked to bring family patterns to life in the present through sculpting and family reconstructions.
- Claiming that techniques were secondary to relationship, she concentrated on the personal relationship between therapist and family to achieve change.
- Satir could envision and sought to support the development of a nurturing triad: two people, for example parents, working for the well-being of another, perhaps a child.
- Satir thought of herself as a detective who sought out and listened for the reflections of self-esteem in the communication of her clients.
- She placed a strong emphasis on the importance of communication and meta-communication in family interactions, and the value of therapeutic validation in the process of change
- From Satir, family therapy gets it model for empathic listening, therapeutic presence, and nurturance.
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