EPPP - Clinical Psychology - Family Therapies

an entity that is maintained by the mutual interactions of its components and assumes that the actions of interacting components are best understood by studying them in their context 

families are viewed as open systems, which continuously receives input from and discharges output to the environment and is more abatable to change 

brought the idea of homeostasis, which is the tendency for a family to act in ways that maintain the family's equilibrium or status quo

introduced the feedback loop to family therapies

negative feedback loop - reduces deviation and helps a systems maintain the status quo

positive feedback loop - amplifies deviation or change and thereby disrupts the system

involves conflicting negative injunctions - e.g., do that and you'll be punishes and don't  do that and you'll be punished - with one injunction often being expressed verbally and the other nonverbally.

all behavior is communication, even doing nothing

communication has a report function and a command function. the report functioning is the content (informational) aspect. the command function is often nonverbal and makes a statement about the relationship between communicators. problems arise when the report and command functions are contradictory 

communication patterns - either symmetrical or complementary 

• symmetrical - reflects equality but may escalate into a competitive or one-upsmanship where participants try to out do each other
• Complementary - reflects inequality and maximizes differences. one is dominant and one is submissive

accept a circular model of causality that regards a symptom as both a cause and effect of dysfunctional communication patterns, which include blaming and criticizing, mindreading, and overgeneralizing

to alter the interactional patterns that are maintaining the presenting symptoms

involves direct techniques such as pointing out to family members problematic interaction patterns as they occur and paradoxical strategies such as prescribing the symptom and reframing

extends general systems theory beyond the nuclear family, and it described the functioning of the extended family and its members in terms of several interlocking concepts

a person's ability to separate their intellectual and emotional functioning 

The lower the differentiation, the more the person is at the mercy of their emotions and the more likely that person will become "fused" with the emotions that dominate the family

a family whose members are highly emotionally fused

when a two-person system (husband/wife, parent/child) experiences instability or stress, a third person may be recruited into the system to increase stability and reduce tension 

the lower the level of differentiation the greater the possibility of an emotional triangle

the process by which parental conflicts and emotional immaturity are transmitted to children

cause child to have lower differentiation than the parents 

often involves the oldest child, a child born during high family stress, or the "special" child

behavioral disorders are the result of a multigenerational transmission process in which progressively lower levels of differentiation are transmitted from one generation to the next

to increase the differentiation of all family members

therapy typically involves 2 family members (usually the spouses) so the therapist can be the third person in the triangle 

as long as the therapist remains objective and neutral, his presence helps family members reduce fusion and achieve higher levels of differentiation 

begins with an assessment to determine presenting problems and involves a genogram. 

during therapy, the therapist is the expert or the coach 

sessions are educative, cognitive, and controlled 

to reduce tension and conflict, partners are encouraged to talk to the therapist and not each other and to speak factual and calm

a key technique is questioning - ask questions designed to defuse emotion and think clearly about their problems

all families have an implicit structure that determines how family members relate to one another.

determines how family members combine forces during times of conflict

pairings within a family such as husband and wife or parent and child

barriers or rules that determine the amount of contact that is allowed between family members

when overly rigid, members are disengaged (isolated) from one another

when too diffuse or permeable, members are enmeshed (overly dependent and close)

occurs when the parents focus on a child by overprotecting or blaming (scapegoating) the child for the family's problems

occurs when a parent and child form a cross-generational coalition and consistently gang up against the other parent

aka unstable coalition, occurs when each parent demands that the child side with him/her against the other parent

The child is constantly pulled in two directions

family dysfunction is the result of inflexible family structure that prohibits the family from adapting to maturational and situational stressors in a healthy way 

example - a family has a child with chronic illness will often exhibit a high degree of enmeshment that limits individual autonomy a long with low tolerance for conflict and overprotectiveness. the child's symptoms help diffuse conflict by diverting attention away from it

restructuring the family is the primary long term goal 

may address symptom relief and other short-term goals

based on the premise that action precedes understanding, and it emphasizes changing behaviors rather than fostering insight

first step in therapy is to develop a therapeutic system by joining the family in a position of leadership. 

involves blending with the family and includes tracking (identifying and using the family's values, life themes, and significant life events in conversation) and mimesis (adopting the family's affective and communication style)

after joining the family, the therapist can evaluate the transactional patterns, power, hierarchies, and boundaries. The therapist can then make a structural diagnosis from which to set specific goals

deliberately unbalance the family's homeostasis in order to facilitate transformation to the family structure.

• techniques include:
• enactment - members are asked to role-play their relationship patterns so they can be identified and alerted 
• reframing - relabeling behaviors so they can be viewed in more positive ways

emphasize the role of communication in maladaptive behavior, especially how it is used to exert control in a relationship

a symptom is an interpersonal phenomenon that represents a strategy, adaptive to a current social situation, for controlling a relationship when all other strategies have failed 

struggle for control becomes pathological when one or both parties deny intent to control the other person and when this produces symptomatic behavior

alleviating current symptoms by altering a family's transactions and organization, especially its hierarchies and generational boundaries

an underlying assumption is that behavior change results in changes in perceptions and emotions

social stage - observe the family's interactions and encourage the involvement of all members

problem stage - gather information about the reasons why the family came to therapy 

interaction stage - family members discuss the identified problem, and the therapist observes their interactions to gather additional information 

goal-setting stage - the therapist and family agree on a contract that defines the goals of treatment

unpleasant tasks the client must perform whenever a symptoms occurs

example - has to by an expensive gift for mother in law every time he argues with her

encourage the family not to change

exaggerating the severity of a symptom

relabeling a symptom to give it a more positive meaning

instructing a family member to deliberately engage in the symptom

there are circular patterns of action and reaction

results when a family's patters become so fixed that family members are no longer able to act creatively or to make new choices about their lives

help family members see their choices and to assist them in exercising their prerogative of choosing 

achieved by using techniques that help families to understand their relationships and problems in alternative ways which leads to new solutions and choices

it uses a therapy team instead of just one therapist. One or two members of the team meet with the family during sessions while the remaining team members observe the session behind a one-way mirror 

the team has frequent conferences and observes may actually call a therapist out of a session to share observation or make suggestions

use initial contact with the family as an opportunity to collect information. the team then creates hypothesizes and tests and revises them as needed.

the therapist remains an ally of the entire family

make use of paradoxical strategies such as the double-bind or reframing to provide family members with information that will help them derive solutions to their own problems

used to help recognize differences and similarities in perceptions 

example - each family member might be asked "who was more upset, mom or dad?"

based on the principles of operant conditioning, social learning theory, and social exchange theory

like all behavior, it is learned and maintained by antecedents and consequences

to alter the environmental factors (antecedents and consequences) that are maintaining problematic behaviors

a focus on observable behaviors 

ongoing assessment of behavior to identify the appropriate targets of therapy and evaluate its effects 

an emphasis on increasing or decreasing target behaviors through the use of reinforcement 

focus on improving communication and problem-solving skills

the result of both intrapsychic and interpersonal factors

to resolve each family member's attachment to family introjects (unconsciously adopt the ideas or attitudes of others)

open 

negative

Lockean

reciprocal

Ackerman 

double-bind

equal 

complementary

fuse

tension

genogram

enmeshed

a stable coalition

joining

communication

resistance 

ordeal

reframe

perceptions

antecedents and consequences 

communication and problem-solving

intrapsychic and interpersonal 

introjects

C

Double-bind communication involves receipt of contradictory messages (often one verbal and one nonverbal) with an inability to comment on those messages. Bateson et al. (1956) identified double-bind communication as an etiological factor in the development of Schizophrenia in a family member.

D

For the exam, you want to be familiar with the differences between low- versus high-context communication and between complementary versus symmetrical communication. In symmetrical communication, the communicators have equal status. A possible negative outcome of this type of communication is that it may escalate into a "one-upmanship" game.

Answer A: This is not the best answer. High-context communication is grounded in the situation, depends on group understanding, relies heavily on nonverbal cues, helps unify a culture, and is slow to change.

Answer B: This is not the best answer. Low-context communication relies primarily on the explicit, verbal part of a message.

Answer C: Complementary communication is based on inequality with one partner assuming a dominant role and the other a subordinate position.

C

Bowen considered an emotional triangle to be a basic building block in a family's emotional system. According to Bowen, when a two-person system such as a husband-wife or parent-child experiences instability or stress, it may form an emotional triangle by recruiting a third person into the system in order to increase stability and reduce tension and anxiety.

Answer A: Though the concept of boundary disturbances is more closely associated with Minuchin, these disturbances would not be alleviated by an emotional triangle as emotional triangles are more likely to occur when there is a low level of differentiation among family members.

Answer B: Emotional triangles do not increase differentiation.

Answer D: The concept of joining is associated with Minuchin's structural family therapy.

D

A distinctive feature of Minuchin's structural family therapy is its use of "joining." Joining entails blending with the family by adopting its language, behaviors, style, etc.

Answer A: This technique is used in communication/interaction family therapy.

Answer B: This is a Bowenian technique.

Answer C: This is another technique employed by Bowenian family therapists.

B

Strategic family therapists use a variety of techniques including paradoxical interventions which are intended to provide symptom relief by ultimately helping the client see the symptom in an alternative way.

Answer A: This is the goal of behavioral family therapy.

Answer C: This is the primary goal of structural family therapy.

Answer D: This is the primary goal of Milan's systemic family therapy.

C

Minuchin, the founder of structural family therapy, distinguished between three types of rigid triads—detouring, stable coalition, and triangulation. Triangulation is one of the rigid triads identified by Minuchin. Though originally defined as involving parents and a child, triangulation can also refer to any triad in which two parties attempt to involve a third party in their conflict and demand the third party's loyalty.

Answer A: Scapegoating occurs when family members blame one member (often the "identified patient") for the family's problem.

Answer B: Mimesis refers to joining a family system by mirroring (imitating) its style, tempo, and affect.

Answer D: Detouring is another rigid triad. It is occurring when parents avoid conflicts between them by focusing on a child.