IV.

Fundamental Concepts of Family Therapy

Systemic Concepts

• Recall that systems theory holds that many problems are a product of the
relationships that surround them.

• The family is a system with characteristics of its own.

• The focus of investigation is on the interaction within and among systems and
individuals.

Cybernetics

• Is concerned with the study of feedback mechanisms in systems.

• Two types of feedback loops:

– Negative, signals the system to restore the status quo

– Positive, signals the need to modify the system.

Both types result in homeostasis.

• Circular causality

– We mutually influence each other via–

• Patterns of Interaction

– Family members’ characteristic ways of behaving.

• Centrality of Communication

– Patterns of interaction expressed are both verbal and nonverbal.

– “One cannot not communicate.”

• Rules

– Define the family

– May be overt or covert

• Boundaries

– Regulate the flow of information in and out of the system

• Triangles

– A three-person system

– Theorists disagree about their stability

• Change
 – 1st Order change is superficial.

– 2nd Order change alters the system.

Family Life Cycle

• Adopted my many family therapists.

• Includes predictable life stages and emotional issues beyond those described by
individual models of development.

• Illustrates inherent family complexity.

• Acknowledges the impact of multiple generations on development.

• For more information on systemic concepts in family therapy–

• http://www.oikos.org/baten.htm

V. Classic Schools of Family Therapy, Part 1

Communication Approaches:
Basic Constructs

• One cannot not communicate.

• All behavior/communication must be observed in context.

• Every system is characterized by rules that maintain the system.

• Relationships are either symmetrical or complementary.

Communication Approaches:
Therapeutic Techniques

• Concrete definition of the problem.

• Investigate all previous solutions.

• Define the change to be made.

• Implement a strategy for change.

Psychodynamic Approaches:
Basic Constructs

• Resolving problems in relationships necessitates intrapsychic exploration.

• Focus on the family-of-origin.

Psychodynamic Approaches:
Therapeutic Techniques

• Individuals, rather than families, are the primary clients.

 • Early relationships, often with parents, are “worked through” to improve current
relationships.

Bowen Family Systems Theory:

Basic Constructs

• To Murray Bowen, the family is an emotional system composed of many

generations, whether living or dead.

• The goal of therapy is the differentiation of self from one’s family-of-origin.

• Individuals who are not differentiated form unstable relationships and are prone to
triangulation.

Bowen Family Systems Theory:

Therapeutic Techniques

• The goal of therapy is differentiation.

• Focus on family and relationship patterns rather than specific issues.

• Look for signs of emotional cut-off and triangles.

• The stance of the therapist is that of observer.

• Therapists must be highly differentiated to avoid the emotionality of the family

system.

• Genograms help clients map multigenerational processes.

Experiential Family Therapy:

Basic Concepts

• Carl Whitaker & Virginia Satir

• Roots in existential/humanistic orientations of individual psychology.

• Dysfunction is seen as the result of denied impulses and feelings.

• Strong emphasis on promoting health and development.

Experiential Family Therapy:

Therapeutic Techniques

• Primary therapeutic goal is growth of all family members.

• Therapist stages family “experiments” in session to facilitate new roles and

behaviors.
VI. Classic Schools of Family Therapy, Part 2
Structural Family Therapy

• Associated with Salvador Minuchin.

• Focused on the balance between stability & change, openness & closedness.

• Its efficacy has been demonstrated with a wide variety of family configurations.

Structural Family Therapy:

Basic Concepts

• Familial patterns of interaction define the structure & organization of the system.

• Three subsystems (spousal, parental, and sibling) must have appropriate boundaries
around them.

• Dysfunctional boundaries may be rigid, allowing little information in or out, or

diffuse, allowing too much information in or out.

• Clear boundaries are firm yet flexible.

Structural Family Therapy:

Therapeutic Techniques

• Structural maps visually represent boundaries and hierarchies between subsystems.

• Therapist must join with the family to affect structural change.

Strategic Family Therapy

• Associated with Jay Haley & the Milan group.

• Views manipulation as an inevitable part of being in relationships.

Strategic Family Therapy:

Basic Concepts

• People behave in ways that are consistent with their conceptual frames; thus,
change the way a problem is defined and you change the problem.

• Families with symptomatic members lack access to alternative conceptual

frameworks.

• Thus, symptoms make sense given the context in which they occur.

Strategic Family Therapy:

Therapeutic Techniques

• Therapy is problem-focused.

• Goal is to change conceptual frameworks.

 • Reframe: an intervention that takes the problem out of its old context and places it
in a new one.

– The new frame must be acceptable to the family.

• Paradox: an intervention that calls for “more of the same.”

Case study

The Kennedy family comes to counseling in hopes of helping the eldest daughter, Rachael
(17 years old), in her struggle with anorexia. David and Melanie, the parents, have been
divorced for 4 years. Rachael’s problems developed when she was 13 years old, around the
time her parents separated.

There are two other children in the family, Jeff (age 12) and Jessica (age 15).

David and Melanie report that their marriage ended because David “came out.”

Another factor in the couple’s history was Melanie’s drinking—she was apparently
physically abusive to the children when she was drinking, resulting in frequent conflict with
David as well. Melanie reports that she has been sober for 4 years.

Rachael, according to her mother, just could not handle her parents’ break-up, the news
that her father was gay, and her mother’s entry into alcohol rehabilitation.

In addition, Rachael reports that she was almost raped by an uncle when she was 15 years
old. Rachael says that when the family lived together, her father was perfectionistic and
demanding, insisting that she perform at the highest levels in schoolwork and athletics.
When she did not meet these standards, he would tell her that she was going nowhere with
her life.

Rachael readily admits that her anorexia is a form of “passive suicide.” Rachael has been
hospitalized three times for her problems and the family is referred to counseling by the
psychiatrist with whom she has most recently been working.

Multiple forms of treatment have been attempted, including hypnosis, antidepressant

medication, individual psychotherapy, music therapy, and Eating Disorders Anonymous.

Rachael reported that until about a year ago she used laxatives, diuretics, and diet pills to
maintain a low body weight.

She currently weighs about 105 pounds and is considered severely underweight for her
height. She restricts her food intake and exercises several times a day. For the most part,
the family is coming to therapy to see if they can help Rachael. However, David does not see
how family therapy can help—he sees the problem as Rachael’s and states that she just
needs to get her act together and start eating.
VII. Contemporary Models of Family Therapy
Postmodernism

• Since the founding of the classic schools of family therapy, there has occurred a shift
in emphasis.

• The postmodern or constructivist position assumes that there is no objective reality.

• Our reality is but one of many shaped by our use of language.

• One consequence has been to make therapists humbler in dealing with families.

Solution-Focused Therapy
Basic Concepts

• This popular model has its roots in the strategic approaches.

• Assumes that people become constrained by narrow, pessimistic views of their

problems.

• Therapists get clients to concentrate on solutions to problems that have worked.

Solution-Focused Therapy:
Therapeutic Techniques

• Formula first session task–asks the client to identify what happens in their life that
they want to continue.

• The miracle question–helps clients look beyond the problem & toward a goal.

• Scaling questions–”On a scale of 1 to 10, how depressed do you feel right now?”

Narrative Therapy:
Basic Concepts

• Concern is with the way people construct meaning rather than the way they behave.

• Personal experience is fundamentally ambiguous and shaped by the words used to

describe it.

• Our explanations of our experiences are our stories and we organize life by them.

Narrative Therapy:
Therapeutic Techniques

• The goal of therapy is to transform clients’ stories and alter their identities.

• This is done by separating people from their problems.

• Exceptions to the prevailing problem narrative are highlighted.

• The centerpiece of therapy is questioning.

How effective is family therapy?

• It appears to be as effective as individual therapies.

• Research is sparse; after all, the field is young.

• It’s likely that different family therapy approaches work for different types of families
and problems.

• For Instance,

• The efficacy of family therapy is most clearly established for

– Marital problems

– Adolescent delinquency

– Substance abuse

• In contrast,

• Family therapy approaches have not been supported for

– Depression

– Chronic eating disorders

– ADHD

• Couples therapy…

• Is more effective than individual therapy for relationship problems:

– Particularly for depressed women

• What makes family therapists effective?

• They tend to be active and in charge,

• They use a wide range of interventions,

• They conduct therapy in a warm, nonthreatening atmosphere,

• There is mutual respect and admiration

“Through there experience of how you are with them, clients can experience themselves
differently, thus planting the seeds of an alternative story.”

- Becvar & Becvar