FAMILY

THERAPY

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HISTO

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THE PRECURSORS

Freud - symptomatic behavior in neurotic individuals.

Adler – Family constellation

Sullivan – interpersonal relations view for families with schizophrenia.- Ludwig von Bertalanffy (1968) – General systems theory and Circular causalityJohn Bell (1961) – Family group therapy

Bowen – Hospitalized families - family emotional systems.

Wynn – pseudomutuality – false sense of closeness

Nathan Ackerman – ‘The Psychodynamics of family life

SCHIZOPHRENIA

• Families were researched (1950)

• Bateson's Palo Alto group.

• Theodore Lidz

• National Institute of Mental Health – Bowen, Wynn.

• Branched out to a systems point of view.

• Double bind communication messages – Mixed messages.

• Marital skew – domination by one whilst the other accepts and children believe its normal.

• Marital Schism – undermine spouse, threats of divorce, looks for loyalty and affection of child.

CURRENT CONCEPTS

Combined into 8 view points

Object Relations Family Therapy

• Psychodynamic view

• Relationships with ‘objects’

• Bring introjects into relationships

• Disturbs the family relations

• Gain insight

EXPERIENTIAL FAMILY THERAPY

Whitaker – Symbolic experiential family therapy

Brings symbols and fantasies so we can grow

Emotion focused couples therapy – change negative interactions focusing on emotional connection

Transgenerational Family Therapy

• Each family member is tied in some way. Individual problems arise and are maintained

• Marries someone similar and the trend continues

• Can result in schizophrenia

STRUCTURAL FAMILY THERAPY

• SALVADOR MINUCHIN

• RULES, ROLES, ALIGNMENTS, COALITIONS, BOUNDARIES, SUBSYSTEMS.

• CHANGE PATTERNS TO UNFREEZE.

• STRATEGIC FAMILY THERAPY

• JAY HALEY – PARADOXICAL INTERVENTIONS

• SYSTEMIC FAMILY THERAPY – DIRTY GAMES AND POWER STRUGGLES

• BOSCOLLO AND CECHING – CIRCULAR QUESTIONING

C.B.T

Cognitive Behavior Family TherapyBehavior – Reinforcement Cognitive – dysfunctional beliefsLearned schemasSocial Constructionist Family Therapy

Challenge systems thinkingLimited lensReality is mediated through language and are socially determined through our relationshipsoffer new alternatives

NARRATIVE THERAPY

Narrative Therapy Michael White – Reality is organized and maintained through our

stories Negative stories are overwhelming Reduce power of problem stories Reclaim successful stories Life is multistoried New alternatives Externalization

PERSONALIT

Y

NA

RI N

E

ContinuityPredictable events

ChangeSituational family crises

Transition points

THEORY OF PERSONALITY

FAMILY RULES

Established expectations

Persistent,

repetitive behaviors

Rules regulate

and stabilize family

system

Redundancy

principle:

Family dysfunction

FAMILY NARRATIVES AND ASSUMPTIONS

Assumptions of self, family and the world

Meanings given to events/situations

Dominant stories/assumptions passed on from one generation to next

Pseudomutuality

Separateness vs.

Togetherness

Pseudohostility

Arguments/Bickering between family

members

PSEUDOMUTUALITY AND PSEUDOHOSTILITY

FRAGMENTED AND IRRATIONAL COMMUNICATION (TO AVOID DEALING WITH UNDERLYING ISSUES)

MYSTIFICATION

Masking the main problem

To distort one’s experience by denying what he/she believes is happening

Contradicts one person’s perception

SCAPEGOATING

Avoid dealing with main issue

Blaming an identified individual for everything that goes wrong

The identified person carries on the role.

ANASTASIA

TREAT

MENT

APPLIC

ATIO

NS

CL A

UD

I A C

HA

ND

L ER

WHO CAN WE HELP?

WHO CAN WE HELP?

INDIVIDUAL PROBLEMS

INTERGENERATIONAL PROBLEMS

MARITAL PROBLEMS

INDIVIDUAL PROBLEMS

WORKING WITH SINGLE INDIVIDUALS

LOOK FOR CONTEXT OF

BEHAVIOR

WHEN PLANNING AND

EXECUTING INTERVENTION

S

WHAT ARE INDIVIDUAL PROBLEMS?

INTERGENERATIONAL PROBLEMS

PARENT & CHILD

PARENT & ADOLESCENT

CONFLICT WITH PARENT OR SOCIETY

OUTDATED RULES AND BOUNDRIES

INTERVENTION

STREINGTHEN PARENTAL

SUBSYSTEM

DEFINE NEW BOUNDRIES &

RULES

WHAT ARE INTERGENERATIONAL PROBLEMS?DELEQUINCY AND AT RISK YOUTH

CHILDREN TO FOREIGN BORN PARENTS

MARITAL PROBLEMS

SYMPTAMATIC BEHAVIOR

TRACE TO EFFORTS BY

THE FAMILY TO DEAL WITH CONFLICT

LOOK FOR INTERPERSONAL DIFFICULTIES

INTERVENTION THROUGH THERAPY

WHAT ARE MARITAL PROBLEMS

INEFFECTIVE COMMUNICATION PATTERNS

SEXUAL INCOMPATABILITIES

ANXIETY OVER MAKING/MAINTINIGN LONG TERM COMITMENT

CONFLICTS OVER:

• MONEY

• IN-LAWS

• CHILDREN

• PHYSICAL ABUSE

• POWER AND CONTROL

WHAT CAN WE DO?

LENGTH OF TREATMENT

BRIEF OF EXTENDED

RELETIVLY SHORT TERM (10-20)

SESSIONS

SETTINGS AND

PRACTITIONERSOUTPATIENT OR

INPATIENTSCHOOLS

HOSPITALS

PSYCHIATRISTS

PSYCHOLOGISTS

MFT’S

SOCIAL WORKERSPASTORAL

COUNCELORS

STAGES OF TREATMENT

BEGINNING – CONTACT, HISTORY

AND RAPPORT

MIDDLE – REDEFINE THE PRESENTING

PROBLEM

END – LEARN COPING SKILLS ANDPROBLEM

SOLVING TECQNIQUES

EVIDENCE

INSURANCE COMPANIES

NEED EVICENCE!

INCREASED FUNDING FOR F.T. RESEARCH

WHICH METHODS

WORK?

WHICH METHODS WORK?

CASE EXAMPL

E

ER

I CA

OB

ER

BACKGROUND: FRANK AND MICHELLE

F RA N K

Fathered two children: Ann (13) and Lance (12.

Widower – Lost wife to cancer.

Children spent a lot of time alone, Ann took over parenting role for her brother Lance.

M I C H E L L E

Mothered one daughter, Jessica (16).

Divorced husband b/c of substance abuse, verbal abuse, and lack of employment.Michelle and Jessica developed a very close mother-daughter relationship for 12 years.

GENOGRAM

PROBLEM

Frank: feeling guilt about not

being an adequate

provider for the family, troubled

with little earnings and medical bills.

Michelle: experiencing

jealousy due to Frank’s frequent business trips,

feeling unattractive and

fearful of abandonment by Frank. Ironically,

her focus on Frank caused her

to abandon Jessica for the

first time.

Jessica: losing closeness to her mother made her

very resentful towards the

entire family, sought comfort and belonging from a school

gang and became a “tagger”.

Ann: feels that Michelle is unable

to fill the responsibility of mothering her

and her brother. Shows no respect towards Michelle,

very bossy.

Lance: unable to properly grieve over the loss of his mother and

stressed by familial conflict,

he began wetting his bed.

INCREASED TENSION BETWEEN THEIR CHILDREN MOSTLY INDIVIDUAL ISSUES THAT WERE TRIGGERED BY THE STRESS OF BECOMING AN “INSTANT FAMILY”

TREATMENT

Provide therapy sessions specific to each major subsystem. Good for strengthening bonds where closeness had been severed.

Frank and Michelle: child-rearing, romantic getaway, alternative income. Jessica, Ann, and Lance: build sibling relationship, give privacy to parents. Frank, Jessica, and Lance: grieving the loss of their mother. Michelle and Jessica: rebuild mother-daughter relationship, discuss Jessica’s

school issues. Frank and Lance: develop father-son bond, help Lance eliminate bedwetting

through behavioral program. Ann: Make her feel special, discuss talents, hobbies, friendships and allow

her to be the child.

Discuss boundary issues with entire family.

FOLLOW-UP

S T R U C T U R A L C H A N G E

Moving forward they were able

to quickly recognize the dyad or triad that caused

dysfunctional patterns and get themselves back

on track.

The family

became more

integrated and better

functioning.

Ann, Lance,

Michelle and Jessica feel much closer to

one another.

B E H A V I O R A L C H A N G E

Frank became proactive at work, received a

promotion and bought the family a larger home.

Lance stopped wetting his bed.

Ann invested her interest in school clubs and

allowed her self to “be a kid”.

Jessica broke away from the school gang and began focusing on

attending a local college.