Review Outline Test 3
Chapter 11 Family Therapy
• Family therapy is both a theory and a treatment method.
• The identified patient is the family member viewed as manifesting problematic behaviors.
• The identified patient’s problematic behaviors are viewed as a reflection of the family’s problematic
interactions.
• Context has broadened to add in the surrounding cultural community.
• Reciprocal causality provides an opportunity to observe repetitive ways in which family members
interact and to use such data to initiate therapeutic interventions.
• Family therapists direct their attention to the dysfunctional or impaired family unit rather than to a
symptomatic person.
• Active empathetic and balanced *
The Family as a System
• Structure- (how it arranges, organizes, and maintains itself at a particular cross section of time)
• Processes- (the way it evolves, adapts, or changes over time).
• Organization & Wholeness- Organization and wholeness are especially important. Systems are
composed of units that stand in some consistent relationship to one another, and thus we can infer that
they are organized around those relationships.
• System
– Linear causality is the simple, nonreciprocal view that one event leads to another in stimulus–
response fashion
– Circular causality- reciprocal actions occur within a relationship network by means of
interacting loops.
– Family homeostasis- When a crisis or other disruption occurs, some family members may try to
maintain or regain a stable environment—family homeostasis —by activating family-learned
mechanisms to decrease the stress and restore internal balance. Others may push for needed
change in the family.
• Negative feedback has an attenuating effect, restoring equilibrium, whereas positive
feedback leads to further change by accelerating the deviation.
• Subsystems
– Spousal- any dysfunction in the spousal subsystem will reverberate throughout the family,
resulting in the scapegoating of children or co-opting them into alliances with one parent against
the other. Effective spousal subsystems provide security and teach children about commitment by
presenting a positive model of marital interaction
– Parental- provides childcare, nurturance, guidance, limit setting, and discipline; problems here
frequently take the form of intergenerational conflicts with adolescents, often reflecting
underlying family disharmony and instability.
– Sibling- help members learn to negotiate, cooperate, compete, and eventually attach to others.
• Boundaries
– are invisible lines that separate a system, a subsystem, or an individual from outside
surroundings.
– Boundaries within a family vary from being rigid (overly restrictive, permitting little contact
among the members of different groups) to being diffuse (overly blurred so that roles are
interchangeable and members are overinvolved in each other’s lives)
– Open systems- The family is open to new experiences, able to alter and discard unworkable or
obsolete interactive patterns, and it operates as an open system.
– Closed systems- When boundaries are not easily crossed, the family is insular, not open to what
is happening around it, suspicious of the outside world, and said to be operating as a closed
system.
, – Disengaged families- Excessively rigid boundaries characterize disengaged families in which
members feel isolated from one another
– Enmeshed families- diffuse boundaries identify enmeshed families in which members are
intertwined in one another’s lives.
• Gender-sensitive outlook
– Stresses importance of not reinforcing stereotypical, sexist, or patriarchal attitudes
• Culturally sensitive therapy
– Requires cultural competence
– Therapist must remain aware of their own “cultural filters” and respect the “cultural filters” of
the family being treated
History
Early approaches focused on individual therapy and the patient–therapist relationship in treating
psychological disorders.
Although theorists believed that families influenced personality, it was often suggested that most
important factors governing human behavior were internal and subjective.
Treatment focused on neurotic conflicts and destructive interactions in the family of origin.
Patients were treated separately from their families.
Family therapists hypothesized psychological problems were developed and maintained in the family
context.
Personality was viewed as related to reciprocal interactional patterns with others.
Psychological dysfunction explained in terms of circular, recursive interpersonal events.
Impact of the child guidance movement
Child guidance clinics were established on premise that psychological problems began in childhood.
View focused on early intervention.
John Bowlby
theorized that children's symptoms were often result of family distress.
Impact of the field of social work
Social workers often visited clients in their homes.
Training centered around interviewing each individual family member to gain a comprehensive picture.
Many social workers became family therapists.
Virginia Satir
Described family roles that serve to stabilize expected characteristic behavior patterns in a family.
Example:
If one child is the “bad child," a sibling may take on the role of the "good child" to alleviate family
stress.
Role reciprocity underscores why family dynamics are resistant to change.
Salvador Minuchin
Founder of structural family therapy.
Author of the classic Families and Family Therapy (1974).
Concepts developed by Minuchin are used to train family therapists to this date.
“Society acts as if all family violence is instrumental, and the response therefore is to increase control.
But it is clear to us as family therapists that most cases of family violence are the products of
generations of powerlessness. When we try to intervene by controlling the parents or with concern for
the child alone, we can only produce a continuation of the pattern.”
— Salvador Minuchin
Jay Haley
Dominant figure in strategic family therapy
Developed a brief therapy model focused on the context and possible function of the patient's symptoms
Utilized directives to instruct patients to act in ways that were counterproductive to their maladaptive
behavior
Focus was on patients doing something about their problems rather than understanding why they had
problems
, Instrumental in bridging the gap between strategic and structural approaches to family therapy
Explored concepts related to triangular and intergenerational relationships
Patient's symptoms seen as the result of incongruence between manifest and covert levels of
communication
Symptoms gave patient a sense of control in their interpersonal relationships.
Therapy focus is on patient taking responsibility for actions and taking a stand.
Therapeutic paradox
Current Status
Eight current approaches
Object Relations Theory- has emphasized the search for satisfactory “objects” (persons) in our lives,
beginning in infancy
o unresolved relationship with one’s parents, and how these imprints from the past—called
introjects—continue to impose themselves on current relationships, particularly with one’s
spouse or children
o the need for a satisfying relationship with some “object” (i.e., another person) is the fundamental
motive of life. From the object relations perspective, we bring introjects —memories of loss or
unfulfillment from childhood—into current dealings with others, seeking satisfaction but
sometimes “contaminating” family relations in the process.
Experiential
o believe that troubled families need a growth experience derived from an intimate interpersonal
experience with an involved therapist. By being real or authentic themselves and often self-
disclosing, experiential therapists contend they can help family members learn to be more
honest, more expressive of their feelings and needs, and better able to use their potential for self-
awareness to achieve personal and interpersonal growth.
Transgenerational
o family members are tied in thinking, feeling, and behavior to the family system and thus
individual problems arise and are maintained by relationship connections with fellow members.
Those persons with the strongest affective connections (or fusion) with the family are most
vulnerable to personal emotional reactions to family stress.
o The degree to which an individualized, separate sense of self independent from the family (or
differentiation of self) occurs is correlated with the ability to resist being overwhelmed by
emotional reactivity in the family; the greater the differentiation, the less likely the individual
will experience personal dysfunction.
Structural
o structural view focuses on how families are organized and on what rules govern members’
transactions. He pays particular attention to family rules, roles, alignments, and coalitions, as
well as to the boundaries and subsystems that make up the overall family system
Strategic
o The strategic family approach involves the designing of novel strategies by the therapist to
eliminate undesired behavior.
o Strategists in the tradition of Jay Haley are not particularly interested in providing insight to
family members; they are more likely to assign tasks to get families to change those aspects of
the system that maintain the problematic behavior.
o Sometimes indirect tasks in the form of paradoxical interventions are used to force clients to
abandon symptoms
o circular questioning to help family members examine their family belief system in the process of
helping to empower them to exercise their prerogative of making new choices for their lives.
Cognitive-behavioral
o The behavioral perspective—the idea that maladaptive or problematic behavior can be
extinguished as the contingencies of reinforcement for that behavior are Altered.
, o Cognitively based couples therapy is directed at restructuring distorted beliefs (called schemas )
learned early in life (from the family of origin, mass media, or the family’s ethnic and
socioeconomic subculture).
Social constructionist
o each of our perceptions is not an exact duplication of the world but a point of view seen through
the limiting lens of our assumptions about people.
o The view of reality each of us constructs is mediated through language and is socially
determined through our relationships with others and with the culture’s shared set of assumptions
o “family story”
Narrative
o our sense of reality is organized and maintained through the stories by which we circulate
knowledge about ourselves and the outside world
Focus of Family Therapy Approaches
• Present-oriented
o Strategic
o Structural
o Social constructivist
o Cognitive-behavioral
o Experiential
• Past-oriented
o Object relations
o Multigenerational
o Narrative
Structural Family Therapy
Family structure
– Invisible set of functional demands that organizes ways in which family members interact
– Operates through transactional patterns
Transactional patterns
– Repeated transactions establish patterns of how, when, and to whom to relate
Boundaries
– Rules defining in a system who participates, how, and when
– Determines the system’s subsystems (i.e., each family structure)
– Continuum ranges from diffuse (“enmeshment”) to rigid (“disengagement”)
Subsystem
– Individuals belong to different subsystems, with different levels of power and skills.
Dysfunction
– Deviation from the healthy or normal
– Dysfunction occurs when one of the following occurs:
– Rigid, diffuse, or unclear boundaries
– Coalitions formed against third party
– Coalitions cross-generational boundaries
– Denied or concealed coalition
Adaptation
– Developmental changes within a family requiring alteration of boundaries
– When adaptation does not occur, it results in dysfunction.
Differences between family therapy and other approaches
Individual and family approaches have blended together considerably.
Main difference remains the degree of focus on the family unit in family therapy.
Personality
– No single, unified theory of personality
– Individual development embedded in context of family life
Chapter 11 Family Therapy
• Family therapy is both a theory and a treatment method.
• The identified patient is the family member viewed as manifesting problematic behaviors.
• The identified patient’s problematic behaviors are viewed as a reflection of the family’s problematic
interactions.
• Context has broadened to add in the surrounding cultural community.
• Reciprocal causality provides an opportunity to observe repetitive ways in which family members
interact and to use such data to initiate therapeutic interventions.
• Family therapists direct their attention to the dysfunctional or impaired family unit rather than to a
symptomatic person.
• Active empathetic and balanced *
The Family as a System
• Structure- (how it arranges, organizes, and maintains itself at a particular cross section of time)
• Processes- (the way it evolves, adapts, or changes over time).
• Organization & Wholeness- Organization and wholeness are especially important. Systems are
composed of units that stand in some consistent relationship to one another, and thus we can infer that
they are organized around those relationships.
• System
– Linear causality is the simple, nonreciprocal view that one event leads to another in stimulus–
response fashion
– Circular causality- reciprocal actions occur within a relationship network by means of
interacting loops.
– Family homeostasis- When a crisis or other disruption occurs, some family members may try to
maintain or regain a stable environment—family homeostasis —by activating family-learned
mechanisms to decrease the stress and restore internal balance. Others may push for needed
change in the family.
• Negative feedback has an attenuating effect, restoring equilibrium, whereas positive
feedback leads to further change by accelerating the deviation.
• Subsystems
– Spousal- any dysfunction in the spousal subsystem will reverberate throughout the family,
resulting in the scapegoating of children or co-opting them into alliances with one parent against
the other. Effective spousal subsystems provide security and teach children about commitment by
presenting a positive model of marital interaction
– Parental- provides childcare, nurturance, guidance, limit setting, and discipline; problems here
frequently take the form of intergenerational conflicts with adolescents, often reflecting
underlying family disharmony and instability.
– Sibling- help members learn to negotiate, cooperate, compete, and eventually attach to others.
• Boundaries
– are invisible lines that separate a system, a subsystem, or an individual from outside
surroundings.
– Boundaries within a family vary from being rigid (overly restrictive, permitting little contact
among the members of different groups) to being diffuse (overly blurred so that roles are
interchangeable and members are overinvolved in each other’s lives)
– Open systems- The family is open to new experiences, able to alter and discard unworkable or
obsolete interactive patterns, and it operates as an open system.
– Closed systems- When boundaries are not easily crossed, the family is insular, not open to what
is happening around it, suspicious of the outside world, and said to be operating as a closed
system.
, – Disengaged families- Excessively rigid boundaries characterize disengaged families in which
members feel isolated from one another
– Enmeshed families- diffuse boundaries identify enmeshed families in which members are
intertwined in one another’s lives.
• Gender-sensitive outlook
– Stresses importance of not reinforcing stereotypical, sexist, or patriarchal attitudes
• Culturally sensitive therapy
– Requires cultural competence
– Therapist must remain aware of their own “cultural filters” and respect the “cultural filters” of
the family being treated
History
Early approaches focused on individual therapy and the patient–therapist relationship in treating
psychological disorders.
Although theorists believed that families influenced personality, it was often suggested that most
important factors governing human behavior were internal and subjective.
Treatment focused on neurotic conflicts and destructive interactions in the family of origin.
Patients were treated separately from their families.
Family therapists hypothesized psychological problems were developed and maintained in the family
context.
Personality was viewed as related to reciprocal interactional patterns with others.
Psychological dysfunction explained in terms of circular, recursive interpersonal events.
Impact of the child guidance movement
Child guidance clinics were established on premise that psychological problems began in childhood.
View focused on early intervention.
John Bowlby
theorized that children's symptoms were often result of family distress.
Impact of the field of social work
Social workers often visited clients in their homes.
Training centered around interviewing each individual family member to gain a comprehensive picture.
Many social workers became family therapists.
Virginia Satir
Described family roles that serve to stabilize expected characteristic behavior patterns in a family.
Example:
If one child is the “bad child," a sibling may take on the role of the "good child" to alleviate family
stress.
Role reciprocity underscores why family dynamics are resistant to change.
Salvador Minuchin
Founder of structural family therapy.
Author of the classic Families and Family Therapy (1974).
Concepts developed by Minuchin are used to train family therapists to this date.
“Society acts as if all family violence is instrumental, and the response therefore is to increase control.
But it is clear to us as family therapists that most cases of family violence are the products of
generations of powerlessness. When we try to intervene by controlling the parents or with concern for
the child alone, we can only produce a continuation of the pattern.”
— Salvador Minuchin
Jay Haley
Dominant figure in strategic family therapy
Developed a brief therapy model focused on the context and possible function of the patient's symptoms
Utilized directives to instruct patients to act in ways that were counterproductive to their maladaptive
behavior
Focus was on patients doing something about their problems rather than understanding why they had
problems
, Instrumental in bridging the gap between strategic and structural approaches to family therapy
Explored concepts related to triangular and intergenerational relationships
Patient's symptoms seen as the result of incongruence between manifest and covert levels of
communication
Symptoms gave patient a sense of control in their interpersonal relationships.
Therapy focus is on patient taking responsibility for actions and taking a stand.
Therapeutic paradox
Current Status
Eight current approaches
Object Relations Theory- has emphasized the search for satisfactory “objects” (persons) in our lives,
beginning in infancy
o unresolved relationship with one’s parents, and how these imprints from the past—called
introjects—continue to impose themselves on current relationships, particularly with one’s
spouse or children
o the need for a satisfying relationship with some “object” (i.e., another person) is the fundamental
motive of life. From the object relations perspective, we bring introjects —memories of loss or
unfulfillment from childhood—into current dealings with others, seeking satisfaction but
sometimes “contaminating” family relations in the process.
Experiential
o believe that troubled families need a growth experience derived from an intimate interpersonal
experience with an involved therapist. By being real or authentic themselves and often self-
disclosing, experiential therapists contend they can help family members learn to be more
honest, more expressive of their feelings and needs, and better able to use their potential for self-
awareness to achieve personal and interpersonal growth.
Transgenerational
o family members are tied in thinking, feeling, and behavior to the family system and thus
individual problems arise and are maintained by relationship connections with fellow members.
Those persons with the strongest affective connections (or fusion) with the family are most
vulnerable to personal emotional reactions to family stress.
o The degree to which an individualized, separate sense of self independent from the family (or
differentiation of self) occurs is correlated with the ability to resist being overwhelmed by
emotional reactivity in the family; the greater the differentiation, the less likely the individual
will experience personal dysfunction.
Structural
o structural view focuses on how families are organized and on what rules govern members’
transactions. He pays particular attention to family rules, roles, alignments, and coalitions, as
well as to the boundaries and subsystems that make up the overall family system
Strategic
o The strategic family approach involves the designing of novel strategies by the therapist to
eliminate undesired behavior.
o Strategists in the tradition of Jay Haley are not particularly interested in providing insight to
family members; they are more likely to assign tasks to get families to change those aspects of
the system that maintain the problematic behavior.
o Sometimes indirect tasks in the form of paradoxical interventions are used to force clients to
abandon symptoms
o circular questioning to help family members examine their family belief system in the process of
helping to empower them to exercise their prerogative of making new choices for their lives.
Cognitive-behavioral
o The behavioral perspective—the idea that maladaptive or problematic behavior can be
extinguished as the contingencies of reinforcement for that behavior are Altered.
, o Cognitively based couples therapy is directed at restructuring distorted beliefs (called schemas )
learned early in life (from the family of origin, mass media, or the family’s ethnic and
socioeconomic subculture).
Social constructionist
o each of our perceptions is not an exact duplication of the world but a point of view seen through
the limiting lens of our assumptions about people.
o The view of reality each of us constructs is mediated through language and is socially
determined through our relationships with others and with the culture’s shared set of assumptions
o “family story”
Narrative
o our sense of reality is organized and maintained through the stories by which we circulate
knowledge about ourselves and the outside world
Focus of Family Therapy Approaches
• Present-oriented
o Strategic
o Structural
o Social constructivist
o Cognitive-behavioral
o Experiential
• Past-oriented
o Object relations
o Multigenerational
o Narrative
Structural Family Therapy
Family structure
– Invisible set of functional demands that organizes ways in which family members interact
– Operates through transactional patterns
Transactional patterns
– Repeated transactions establish patterns of how, when, and to whom to relate
Boundaries
– Rules defining in a system who participates, how, and when
– Determines the system’s subsystems (i.e., each family structure)
– Continuum ranges from diffuse (“enmeshment”) to rigid (“disengagement”)
Subsystem
– Individuals belong to different subsystems, with different levels of power and skills.
Dysfunction
– Deviation from the healthy or normal
– Dysfunction occurs when one of the following occurs:
– Rigid, diffuse, or unclear boundaries
– Coalitions formed against third party
– Coalitions cross-generational boundaries
– Denied or concealed coalition
Adaptation
– Developmental changes within a family requiring alteration of boundaries
– When adaptation does not occur, it results in dysfunction.
Differences between family therapy and other approaches
Individual and family approaches have blended together considerably.
Main difference remains the degree of focus on the family unit in family therapy.
Personality
– No single, unified theory of personality
– Individual development embedded in context of family life
