Family in Schizophrenia

Family Therapy Theory
Doherty, W. J., and Baptiste, D. A.,

Jr. (1993). Theories emerging from
family therapy. In P.G. Boss, W. J.
Doherty, R. LaRossa, W. R. Schumm, &
S. K. Steinmetz (Eds.), Sourcebook of
family theories and methods: A
contextual approach (pp. 505-524).
New York: Plenum.
Historical Development
 Gregory Bateson suggested two forms of
communication:
 Verbal (a/k/a digital): what is said.
 Nonverbal (a/k/a analogic): provides the
context for the digital, providing interpretative
information. This is referred to as a
metamessage.
 The Palo Alto Team:
 Double bind hypothesis: a sequence of
interaction which featured a contradiction
between the contextual and verbal levels.
 Family homeostasis, influenced by
cybernetics: families were calibrated like a
furnace to maintain themselves within
tolerable limits.
Dr. Ronald J. Werner-Wilson

Historical Development (cont.)
 Murray Bowen
 Use a biological metaphor which linked
individual and family differentiation.
 Family process influenced an individual
differentiation of self, a balance between
 intellectual and emotional functioning.
 autonomy and togetherness in social
relationships.
 Families transmit level of differentiation.
 Salvador Minuchin: Structural Family
Therapy
 Families have functions which:
 socialization of children
 mutual support or married couples.
 Families are systems which operate through
subsystems which require adequate boundary
clarity and permeability.
 Family problems are the result of
 boundaries which are too porous
(enmeshed)
 boundaries which are too rigid
(disengaged).
Historical Development (cont.)
 Recent Developments
 Milan approach
 Constructivism: infusion of epistemology
(theories of knowing) and other ideas.
 Reality cannot be assessed objectively
because it is a subjective experience.
 Reflexivity: the observer is part of the
system being observed.

Working Assumptions of Family
Therapy Theories
 Family relationships are a principal
source of mental health and
psychopathology for individuals.
 Family interaction patterns tend to repeat
across generations.
 Family health requires a balance of
connection and individuation.
 Family flexibility is a core trait that
prevents family dysfunction.
 The triad is the minimum unit for a
complex understanding of family
interactions.
 Individuals' symptoms frequently have
meaning within the family's interaction
patterns or worldview.

Major Questions Addressed by
Family Therapy Theories
 How do individuals develop psychosocial
symptoms within families?
 How do families maintain levels of
interpersonal connection that allow for
emotional bonding and individual
autonomy?
 How does family conflict become
unmanageable?
 How can families change dysfunctional
patterns?

Major Contemporary Concepts
 Boundaries: family rules which determine

membership in systems and responsibilities.
 Triangles: triadic interactional configurations
which is the basic building block of any
emotional system. When a two-party system
becomes unstable because of anxiety, a third
person is involved to stabilize them.
 Coalitions: negative alliances between two or
more family members, a version of triangles.
 Family belief systems: problems are
maintained by the families construction of the
problem.
 Self Processes: The field is divided into two
groups
 One group emphasizes only family processes.
 A second group is influenced by one of two
theoretical orientations
 Object relations concepts (e.g., Framo,
Scharff & Scharff).
 Self-differentiation (Bowen).
Family Therapy Theory and Research
on Psychosomatic Families
 Theory: enmeshed, overprotective, rigid,
and inadequate conflict resolution
transactional patterns are associated with
the following medial problems:
 anorexia nervosa
 poor control of diabetes
 asthma
 Results: general support for hypothesis.
 Children from psychosomatic families had
higher levels of FFA than control group when
they observed parental conflict.
 Parents in psychosomatic families relaxed
when children entered the room; the child’s
FFA level increased.

Family Therapy Theory and
Research on Schizophrenia
 Major contributions to the understanding of
schizophrenia only occurred after researchers
accepted the notion that it is a biologically based
disease.
 Researchers began to study the influence of
family factors intensify problems and lead to
relapse.
 Expressed Emotion (EE):
 Refers to the level of criticalness and
emotional overinvolvement of a family
member to another family member with a
psychiatric impairment.
 Measured during a Camberwell Family
Interview, a 90-minute semi-structured
interview.
 People from high EE families are likely to
relapse three to four times more rapidly.
 Expressed emotion has also been used to
predict relapse in
 depression,
 manic-depressive disorder,
 obesity.
Limitations of Family Therapy
Theory
 Two Standard Criticisms:
 Individual psychological factors were
neglected.
 Lack of clear operationalization of the
constructs for research purposes.
 Three New Critiques:
 Feminist Critique
 Race/Ethnic Diversity
 Systems in Context: Need to Examine Larger
Social Systems

Theory (cont.)
 Feminist Critique: Doherty and Baptiste
(1993) suggest that feminism has entered
the mainstream of theoretical work in
family therapy. Main points of the
feminist critique:
 Traditional theory ignored gender.
 Traditional theory ignored sociocultural and
political contexts of family life.
 Traditional theory reinforced traditional roles.
 Traditional theory ignored issues of power and
differential vulnerability of men and women to
exploitation (Doherty & Baptiste, 1993, p.
518).

Theory (cont.)
 Critique Based on Race/Ethnicity. Two
problems:
 Theoretical myth of sameness.
 Use of stereotypes.
 Critique Based on Larger Social Systems:
 Families are influenced by their interactions
with major environmental systems (e.g.,
health care system, schools, legal system,
mental health and social service systems).
 Emerging consensus, as a result of
collaboration with medical professionals:
adequate family theory must involve a
biopsychosocial perspective (e.g., mind, body,
and larger social systems).

Future Directions
 Emergent Trends
 Greater link between theory and assessment.
 Greater emphasis on biopsychosocial models.
 Emphasis on constructivist approaches to
family theory. Analysis of the family as a group
that
 observes itself and its environment
 formulates hypotheses, and holds lasting
belief patterns (Doherty & Baptiste, 1993,
p. 521).
 Emphasize race/ethnicity and gender.
 Two Divergent Paths
 Theory that is tied directly to research
activities.
 Theory that is influenced by nontraditional
research paradigms which emphasize
epistemology (theory of knowing) and
properties of interacting therapeutic systems.

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Family Therapy Theory

Doherty, W. J., and Baptiste, D. A.,

Dr. Ronald J. Werner-Wilson

Dr. Ronald J. Werner-Wilson

Dr. Ronald J. Werner-Wilson

Dr. Ronald J. Werner-Wilson

 Boundaries: family rules which determine

Dr. Ronald J. Werner-Wilson

Dr. Ronald J. Werner-Wilson

Dr. Ronald J. Werner-Wilson

Dr. Ronald J. Werner-Wilson

Dr. Ronald J. Werner-Wilson

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