INTRODUCTION TO FAMILY THERAPY by Jaime Lavid

AN INTRODUCTION TO

FAMILY THERAPY

Tags: Family Therapy - Practical Guide – Manual – Theory – Summary - Course – counselling – counsellor

Preface All information in this manual was collected for personal use from freely accessible sites on the internet, a lot of it was found in the free encyclopaedia Wikipedia. The same applies to all pictures used, which I downloaded from public domain sites. Since I feel many people will benefit and appreciate being allowed to get easy access to this kind of information ordered in short, easily accessible chapters, I decided to make it available for free to everybody. Should any of the authors of the borrowed texts feel that the present manual is not compatible with the way in which they planned to make their work available to the public, then I hereby invite them to contact me at jaimelavie.7264@yahoo.com and let me know which part of the manual should be replaced by information from other sources. Please check on unibook.com or lulu.com for a printed version of this manual.

FAMILY THERAPY CONTENTS Family Therapy – Wikipedia • • • • • • • • • • •

1 History and theoretical frameworks 2 Techniques 3 Publications 4 Licensing and degrees o 4.1 Values and ethics in family therapy 5 Founders and key influences 6 Summary of Family Therapy Theories & Techniques 7 Academic resources 8 Professional Organizations 9 See also 10 References 11 External links

5 6 9 10 11

Brief Strategic Family Therapy

Strategic Family Therapy – Kimberly Gail

Solution Focused Brief Therapy – Wikipedia

• • • • • • •

1 Basic Principles 2 Questions 3 Resources 4 History of Solution Focused Brief Therapy 5 Solution-Focused counselling 6 Solution-Focused consulting 7 References

Brief (psycho-) Family Therapy – Wikipedia

Extended Family Therapy or Bowenian Family Systems Therapy I - Wikipedia

• • • • • • • • • • • • • •

Introduction Differentiation of Self Triangles The Nuclear Family Emotional Processes The Family Projection Process The Multigenerational Transmission Process Sibling Position Emotional Cutoff Societal Emotional Processes Normal Family Development Family Disorders Goals of Therapy Techniques Family Therapy with One Person

31 33 36 38 41 45 48 50 52 54 54 55

Bowen’s Family Systems Therapy II • More about triangles

56 62

Salvador Munichin’s Structural Family Therapy - I

Virginia Satir’s Humanistic Family Therapy

Behavourial & Conjoint Family Therapy

Milan Systemic Family Therapy or “Long Brief Therapy”

Response Based Therapy – Wikipedia

Narrative Family Therapy I - Wikipedia

Narrative Family Therapy II

Definitions

Basic Family Therapy Techniques

• • • • • •

Techniques for Information Gathering Joining Diagnosing Family System Strategies Intervention Techniques Communication Skill Building Techniques

87 88 89 89 90 95

Structure of a Family Therapy Session

Stages and steps of Problem Centred Systems Therapy - Can.Fam.Physician

A guideline for family assessment

Structure of Family Therapy

100

Systemic Family Therapy Manual

103

Basic Family Therapy Techniques in alphabetical order

153

Summary of Family Therapy Theories and Techniques

164

Family Therapy Survey

167

FAMILY THERAPY From Wikipedia, the free encyclopedia Family therapy, also referred to as couple and family therapy and family systems therapy, is a branch of psychotherapy that works with families and couples in intimate relationships to nurture change and development. It tends to view change in terms of the systems of interaction between family members. It emphasizes family relationships as an important factor in psychological health. What the different schools of family therapy have in common is a belief that, regardless of the origin of the problem, and regardless of whether the clients consider it an "individual" or "family" issue, involving families in solutions is often beneficial. This involvement of families is commonly accomplished by their direct participation in the therapy session. The skills of the family therapist thus include the ability to influence conversations in a way that catalyzes the strengths, wisdom, and support of the wider system. In the field's early years, many clinicians defined the family in a narrow, traditional manner usually including parents and children. As the field has evolved, the concept of the family is more commonly defined in terms of strongly supportive, long-term roles and relationships between people who may or may not be related by blood or marriage. Family therapy has been used effectively in the full range of human dilemmas; there is no category of relationship or psychological problem that has not been addressed with this approach. The conceptual frameworks developed by family therapists, especially those of family systems theorists, have been applied to a wide range of human behaviour, including organizational dynamics and the study of greatness.

Contents • • • • • • • • • • •

History of Marital Therapy Gurman, A. S. & Fraenkel, P. (2002). The history of couple therapy: A millennial review. Family Process, 41, 199-260. G&F point out that couples therapy (formerly marital therapy) has been largely neglected, even though family therapists do 1.52 times as much couple work as multigenerational family work. They also note this is not such a bad ratio, as 40% of people coming to therapy attribute their problems to relationship issues. G&F define Four Phases in the History Couples Therapy: Phase I - 1930 to 1963 Atheoretical • • • •

1929 to 1932 - Three marital clinics opened; they were service and education oriented, and saw mostly individuals The closest thing to theory was what was borrowed from psychoanalytic - interlocking neurosis 1931 the first marital therapy paper was published Theory was marginalized due to a lack of brilliant theorists, and a lack of distinction from individual analysis

Phase II - 1931 to 1966 Psychoanalytic Experimentation • • • •

Therapists are seen as telling truth from distortion, rather than creating a truth Mostly individual sessions, but some conjoint; still treated like seeing two individual clients in the same room though Some started to downplay the role of the therapist Family was outshining couples work, and the couple techniques weren't innovative or particularly effective

Phase III - 1963 to 1985 Family Therapy Incorporates •

Family therapy overpowers couples, even though a number of big name people really mostly saw couples o Jackson Coined concepts like quid pro quo, homeostasis, and double bind for conjoint therapy o Satir Coined naming roles members played, fostered self-esteem and actualization, and saw the therapist as a nurturing teacher o Bowen Multigenerational theory approach, with differentiation, triangulation, and projection processes, with the therapist as an anxiety-lowering coach - societal projection process was the forerunner of our modern awareness of cultural differences Copied from the web. o Haley Power and control (or love and connection) were key. Avoided insight, emotional catharsis, conscious power plays. Saw system as more, and more important, than the sum of the parts

Phase IV - 1986 to now Refining and Integrating • •

• • • •

1986 was the publication of G&K book New Theories were tried and refined, like Behavioral Marital Therapy, Emotionally Focused Marital Therapy, and Insight-Oriented Marital Therapy. All four have received good empirical support. Couples therapy was used to treat depression, anxiety, and alcoholism. Efforts were focused on preventing couples problems with programs like PREP Feminism, Multiculturalism, and Post-Modernism impacted the field Eclectic integration, brief therapy, and sex therapy ideas were incorporated into our work Copied from the web. http://www.psychpage.com/family/library/history_of_couples_therapy.html

History and theoretical frameworks Formal interventions with families to help individuals and families experiencing various kinds of problems have been a part of many cultures, probably throughout history. These interventions have sometimes involved formal procedures or rituals, and often included the extended family as well as non-kin members of the community (see for example Ho'oponopono). Following the emergence of specialization in various societies, these interventions were often conducted by particular members of a community – for example, a chief, priest, physician, and so on - usually as an ancillary function.[1] Family therapy as a distinct professional practice within Western cultures can be argued to have had its origins in the social work movements of the 19th century in England and the United States.[1] As a branch of psychotherapy, its roots can be traced somewhat later to the early 20th century with the emergence of the child guidance movement and marriage counselling.[2] The formal development of family therapy dates to the 1940s and early 1950s with the founding in 1942 of the American Association of Marriage Counsellors (the precursor of the AAMFT), and through the work of various independent clinicians and groups - in England (John Bowlby at the Tavistock Clinic), the US (John Bell, Nathan Ackerman, Christian Midelfort, Theodore Lidz, Lyman Wynne, Murray Bowen, Carl Whitaker, Virginia Satir), and Hungary (D.L.P. Liebermann) - who began seeing family members together for observation or therapy sessions.[1][3] There was initially a strong influence from psychoanalysis (most of the early founders of the field had psychoanalytic backgrounds) and social psychiatry, and later from learning theory and behaviour therapy and significantly, these clinicians began to articulate various theories about the nature and functioning of the family as an entity that was more than a mere aggregation of individuals.[2] The movement received an important boost in the mid-1950s through the work of anthropologist Gregory Bateson and colleagues – Jay Haley, Donald D. Jackson, John Weakland, William Fry, and later, Virginia Satir, Paul Watzlawick and others – at Palo Alto in the US, who introduced ideas from cybernetics and general systems theory into social psychology and psychotherapy, focusing in particular on the role of communication (see Bateson Project). This approach eschewed the traditional focus on individual psychology and historical factors – that involve so-called linear causation and content – and emphasized instead feedback and homeostatic mechanisms and “rules” in here-and-now interactions – so-called circular causation and process – that were thought to maintain or exacerbate problems, whatever the original cause(s).[4][5] (See also systems psychology and systemic therapy.) This group was also influenced significantly by the work of US psychiatrist, hypnotherapist, and brief therapist, Milton H. Erickson - especially his innovative use of strategies for change, such as paradoxical directives (see also Reverse psychology). The members of the Bateson Project (like the founders of a number of other schools of family therapy, including Carl Whitaker, Murray Bowen, and Ivan Böszörményi-Nagy) had a particular interest in the possible psychosocial causes and treatment of schizophrenia, especially in terms of the putative "meaning" and "function" of signs and symptoms within the family system. The research of psychiatrists and psychoanalysts Lyman Wynne and Theodore Lidz on communication deviance and roles (e.g., pseudo-mutuality, pseudo-hostility, schism and skew) in families of schizophrenics also became influential with systems-communications-oriented theorists and therapists.[2][6] A related theme, applying to dysfunction and psychopathology more generally, was that of the "identified patient" or "presenting problem" as a manifestation of or surrogate for the family's, or even society's, problems. (See also double bind; family nexus.) By the mid-1960s a number of distinct schools of family therapy had emerged. From those groups that were most strongly influenced by cybernetics and systems theory, there came MRI Brief Therapy, and slightly later, strategic therapy, Salvador Minuchin's Structural Family Therapy and the Milan systems model. Partly in reaction to some aspects of these systemic models, came the experiential approaches of Virginia Satir and Carl Whitaker, which downplayed theoretical constructs, and emphasized subjective experience and unexpressed feelings (including the subconscious), authentic communication, spontaneity, creativity, total therapist engagement, and often included the extended family. Concurrently and somewhat independently, there emerged the various intergenerational therapies of Murray Bowen, Ivan Böszörményi-Nagy, James Framo, and Norman Paul, which present different theories about the intergenerational transmission of health and dysfunction, but which all deal usually with at least three generations of a family (in person or conceptually), either directly in therapy sessions, or via "homework", "journeys home", etc. Psychodynamic family therapy - which, more than any other school of family therapy, deals directly with individual psychology and the unconscious in the context of current relationships - continued to develop

through a number of groups that were influenced by the ideas and methods of Nathan Ackerman, and also by the British School of Object Relations and John Bowlby’s work on attachment. Multiple-family group therapy, a precursor of psychoeducational family intervention, emerged, in part, as a pragmatic alternative form of intervention - especially as an adjunct to the treatment of serious mental disorders with a significant biological basis, such as schizophrenia - and represented something of a conceptual challenge to some of the "systemic" (and thus potentially "family-blaming") paradigms of pathogenesis that were implicit in many of the dominant models of family therapy. The late-1960s and early-1970s saw the development of network therapy (which bears some resemblance to traditional practices such as Ho'oponopono) by Ross Speck and Carolyn Attneave, and the emergence of behavioural marital therapy (renamed behavioural couples therapy in the 1990s; see also relationship counselling) and behavioural family therapy as models in their own right.[2] By the late-1970s the weight of clinical experience - especially in relation to the treatment of serious mental disorders - had led to some revision of a number of the original models and a moderation of some of the earlier stridency and theoretical purism. There were the beginnings of a general softening of the strict demarcations between schools, with moves toward rapprochement, integration, and eclecticism – although there was, nevertheless, some hardening of positions within some schools. These trends were reflected in and influenced by lively debates within the field and critiques from various sources, including feminism and post-modernism, that reflected in part the cultural and political tenor of the times, and which foreshadowed the emergence (in the 1980s and 1990s) of the various "post-systems" constructivist and social constructionist approaches. While there was still debate within the field about whether, or to what degree, the systemic-constructivist and medical-biological paradigms were necessarily antithetical to each other (see also Anti-psychiatry; Biopsychosocial model), there was a growing willingness and tendency on the part of family therapists to work in multi-modal clinical partnerships with other members of the helping and medical professions.[2][6][7] From the mid-1980s to the present the field has been marked by a diversity of approaches that partly reflect the original schools, but which also draw on other theories and methods from individual psychotherapy and elsewhere – these approaches and sources include: brief therapy, structural therapy, constructivist approaches (e.g., Milan systems, post-Milan/collaborative/conversational, reflective), solution-focused therapy, narrative therapy, a range of cognitive and behavioural approaches, psychodynamic and object relations approaches, attachment and Emotionally Focused Therapy, intergenerational approaches, network therapy, and multisystemic therapy (MST).[8][9][10][11][12][13][14][15] Multicultural, intercultural, and integrative approaches are being developed.[16][17][18][19][20][21] Many practitioners claim to be "eclectic," using techniques from several areas, depending upon their own inclinations and/or the needs of the client(s), and there is a growing movement toward a single “generic” family therapy that seeks to incorporate the best of the accumulated knowledge in the field and which can be adapted to many different contexts;[22] however, there are still a significant number of therapists who adhere more or less strictly to a particular, or limited number of, approach(es).[23] Ideas and methods from family therapy have been influential in psychotherapy generally: a survey of over 2,500 US therapists in 2006 revealed that of the ten most influential therapists of the previous quarter-century, three were prominent family therapists, and the marital and family systems model was the second most utilized model after cognitive behavioural therapy.[24] As we move through the 21st century, the internet is fostering the growth of online programs that make courses and programs in family therapy more widely accessible. Using mass media techniques to increase public understanding of issues in family therapy has added a new frontier for amplification in the future.

Techniques Family therapy uses a range of counselling and other techniques including: • • • • • • • •

communication theory media and communications psychology psychoeducation psychotherapy relationship education systemic coaching systems theory reality therapy

The number of sessions depends on the situation, but the average is 5-20 sessions. A family therapist usually meets several members of the family at the same time. This has the advantage of making differences between the ways family members perceive mutual relations as well as interaction patterns in the session apparent both for the therapist and the family. These patterns frequently mirror habitual interaction patterns at home, even though the therapist is now incorporated into the family system. Therapy interventions usually focus on relationship patterns rather than on analyzing impulses of the unconscious mind or early childhood trauma of individuals as a Freudian therapist would do - although some schools of family therapy, for example psychodynamic and intergenerational, do consider such individual and historical factors (thus embracing both linear and circular causation) and they may use instruments such as the genogram to help to elucidate the patterns of relationship across generations. The distinctive feature of family therapy is its perspective and analytical framework rather than the number of people present at a therapy session. Specifically, family therapists are relational therapists: They are generally more interested in what goes on between individuals rather than within one or more individuals, although some family therapists—in particular those who identify as psychodynamic, object relations, intergenerational, EFT, or experiential family therapists—tend to be as interested in individuals as in the systems those individuals and their relationships constitute. Depending on the conflicts at issue and the progress of therapy to date, a therapist may focus on analyzing specific previous instances of conflict, as by reviewing a past incident and suggesting alternative ways family members might have responded to one another during it, or instead proceed directly to addressing the sources of conflict at a more abstract level, as by pointing out patterns of interaction that the family might have not noticed. Family therapists tend to be more interested in the maintenance and/or solving of problems rather than in trying to identify a single cause. Some families may perceive cause-effect analyses as attempts to allocate blame to one or more individuals, with the effect that for many families a focus on causation is of little or no clinical utility.

Publications Family therapy journals include: Journal of Marital and Family Therapy, Family Process, Journal of Family Therapy, Journal of Systemic Therapies, The Australian & New Zealand Journal of Family Therapy, The Psychotherapy Networker, The Journal of Sex and Marital Therapy, The Australian Journal of Family Therapy, The International Journal of Narrative Therapy and Community Work, Journal for the Study of Human Interaction and Family Therapy,

Licensing and degrees Family therapy practitioners come from a range of professional backgrounds, and some are specifically qualified or licensed/registered in family therapy (licensing is not required in some jurisdictions and requirements vary from place to place). In the United Kingdom, family therapists are usually psychologists, nurses, psychotherapists, social workers, or counsellors who have done further training in family therapy, either a diploma or an M.Sc.. However, in the United States there is a specific degree and license as a Marriage and Family therapist. Prior to 1999 in California, counsellors who specialized in this area were called Marriage, Family and Child Counsellors. Today, they are known as Marriage and Family Therapists (MFT), and work variously in private practice, in clinical settings such as hospitals, institutions, or counselling organizations. A master's degree is required to work as an MFT in some American states. Most commonly, MFTs will first earn a M.S. or M.A. degree in marriage and family therapy, psychology, family studies, or social work. After graduation, prospective MFTs work as interns under the supervision of a licensed professional and are referred to as an MFTi.[25] Marriage and family therapists in the United States and Canada often seek degrees from accredited Masters or Doctoral programs recognized by the Commission on Accreditation for Marriage and Family Therapy Education(COAMFTE), a division of the American Association of Marriage and Family Therapy. For accredited programs, click here. Requirements vary, but in most states about 3000 hours of supervised work as an intern are needed to sit for a licensing exam. MFTs must be licensed by the state to practice. Only after completing their education and internship and passing the state licensing exam can a person call themselves a Marital and Family Therapist and work unsupervised. License restrictions can vary considerably from state to state. Contact information about licensing boards in the United States are provided by the Association of Marital and Family Regulatory Boards. There have been concerns raised within the profession about the fact that specialist training in couples therapy â&#x20AC;&#x201C; as distinct from family therapy in general - is not required to gain a license as an MFT or membership of the main professional body, the AAMFT.[26]

Values and ethics in family therapy Since issues of interpersonal conflict, power, control, values, and ethics are often more pronounced in relationship therapy than in individual therapy, there has been debate within the profession about the different values that are implicit in the various theoretical models of therapy and the role of the therapistâ&#x20AC;&#x2122;s own values in the therapeutic process, and how prospective clients should best go about finding a therapist whose values and objectives are most consistent with their own.[27][28][29] Specific issues that have emerged have included an increasing questioning of the longstanding notion of therapeutic neutrality,[30][31][32] a concern with questions of justice and self-determination,[33] connectedness and independence,[34] "functioning" versus "authenticity",[7] and questions about the degree of the therapistâ&#x20AC;&#x2122;s "pro-marriage/family" versus "pro-individual" commitment.[35]

Founders and key influences Some key developers of family therapy are: • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • •

Alfred Adler (phenomenology) Nathan Ackerman (psychoanalytic) Tom Andersen (Reflecting practices and dialogues about dialogues) Harlene Anderson (Postmodern Collaborative Therapy and Collaborative Language Systems) Harry J Aponte (Person-of-the-Therapist) Gregory Bateson (1904–1980) (cybernetics, systems theory) Ivan Böszörményi-Nagy (Contextual therapy, intergenerational, relational ethics) Murray Bowen (Systems theory, intergenerational) Steve de Shazer (solution focused therapy) James Dobson (Christian psychologist) Focus on the Family Milton H. Erickson (hypnotherapy, strategic therapy, brief therapy) Richard Fisch (brief therapy, strategic therapy) James Framo (object relations theory, intergenerational) Edwin Friedman (Family process in religious congregations) Harry Goolishian (Postmodern Collaborative Therapy and Collaborative Language Systems) John Gottman (marriage) Robert-Jay Green (LGBT, cross-cultural issues) Jay Haley (strategic therapy, communications) Lynn Hoffman (strategic, post-systems, collaborative) Don D. Jackson (systems theory) Sue Johnson (Emotionally focused therapy, attachment theory) Bradford Keeney (cybernetics, resource focused therapy) Walter Kempler (Gestalt psychology) Bernard Luskin (media psychology, Public understanding of issues through media) Cloe Madanes (strategic therapy) Salvador Minuchin (structural) Braulio Montalvo (structural)[citation needed] Virginia Satir (communications, experiential, conjoint and co-therapy) Mara Selvini Palazzoli (Milan systems) Ross Speck (network therapy) Robin Skynner (Group Analysis) Paul Watzlawick (Brief therapy, systems theory) John Weakland (Brief therapy, strategic therapy, systems theory) Carl Whitaker (Family systems, experiential, co-therapy) Michael White (narrative therapy) Lyman Wynne (Schizophrenia, pseudomutuality)

Principal Leaders in the Field: • • • • • •

Salvador Minuchin Jay Haley Murray Bowen Nathan Ackerman Virginia Satir Ivan Boszmormenyi-Nagy

• • • • • •

John Elderkin Bell Philip Guerin Don Jackson Carl Whitaker Betty Carter Michael White

Salvador Minuchin Born and raised in Argentina, Salvador Minuchin began his career as a family therapist in the early 1960's when he discovered two patterns common to troubled families: some are "enmeshed," chaotic and tightly interconnected, while others are "disengaged," isolated and seemingly unrelated. When Minuchin first burst onto the scene, his immediate impact was due to his dazzling clinical artistry. This compelling man with the elegant Latin accent would provoke, seduce, bully, or bewilder families into changing -- as the situation required -- setting a standard against which other therapists still judge their best work. But even Minuchin's legendary dramatic flair didn't have the same galvanizing impact as his structural theory of families. In his classic text, Families and Family Therapy (Minuchin, 1974) Minuchin taught family therapists to see what they were looking at. Through the lens of structural family theory, previously puzzling interactions suddenly swam into focus. Where others saw only chaos and cruelty, Minuchin helped us understand that families are structured in "subsystems" with "boundaries," their members shadowing to steps they do not see. In 1962 Minuchin formed a productive professional relationship with Jay Haley, who was then in Palo Alto. In 1965 Munuchin became the director of the Philadelphia Child Guidance Clinic, which eventually became the world's leading center for family therapy and training. At the Philadelphia Clinic, Haley and Minuchin developed a training program for members of the local black community as paraprofessional family therapists in an effort to more effectively related to the urban blacks and Latinos in the surrounding community. In 1969, Minuchin, Haley, Braulio Montalvo, and Bernice Rosman developed a highly successful family therapy training program that emphasized hands-on experience, on-line supervision, and the use of videotapes to learn and apply the techniques of structural family therapy. Minuchin stepped down as director of the Phildelphia Clinic in 1975 to pursue his interest in treating families with psychosomatic illnesses and to continue writing some of the most influential books in the field of family therapy. In 1981, Minuchin established Family Studies, Inc., in New York, a center committed to teaching family therapists. Minuchin retired in 1996 and currently lives with his wife Patricia in Boston.

Jay Haley A brilliant strategist and devastating critic, Jay Haley was a dominating figure in developing the Palo Alto Group's communcations model and stategic family therapy, which became popular in the 1970's. He studied under three of the most influential pioneers in the evolution of family therapy - Gregory Bateson, Milton Erickson, and Salvador Minuchin, and combined ideas from each of these innovative thinkers to form his own unique brand of family therapy. In 1953 Haley was studying for a master's degree in communication at Stanford University when Gregory Bateson invited him to work on the schizophrenia project. Haley met with patients and their families to observe the communicative style of schizophrenics in a natural environment. This work had an enormous impact in shaping the development of family therapy. Haley developed his therapeutic skills under the supervision of master hypnotist Milton Erickson from 1954 to 1960. Haley developed a brief therapy model which focused on the context and possible function of the patient's symptoms and used directives to instruct patients to act in ways that were counterproductive to their maladaptive behavior. Haley believed that it was far more important to get patients to actively do something about their problems rather than help them to understand why they had these problems. Haley was instumental in bridging the gap between strategic and structural approaches to family therapy by looking byond simple dyadic relationships and exploring his interest in trangular, intergenerationsl relationships, or "perverse triangles." Haley believed that a patient's symptoms arose out of an incongruence between manifest and covert levels of communication with others and served to give the patient a sense of control in their interpersonal relationships. Accordingly, Haley thought that the healing aspect of the patient-therapist relationship involved getting patients to take responsibility for their actions and to take a stand in the therapeutic relationship, a process he called "therapeutic paradox." Haley conducted research at the Mental Research Institute in Palo Alto until he joined Salvador Minuchin at the Philadelphia Child Guidance Clinic in 1967. At the Philadelphia Clinic, Haley pursued his interests in training and supervision in family therapy and was the director of family therapy research for ten years. He was also an active clinical member of the University of Pennsylvania's Department of Psychiatry. In 1976, Haley moved to Washington D.C. and founded the Family Therapy Institute with Cloe Madanes, which has become one of the major training institutes in the country. Haley retired in 1995 and currently lives in La Jolla, California.

Murray Bowen Among the pioneers of family therapy, Murray Bowen's emphasis on theory and insight as opposed to action and technique distinguish his work from the more behaviorally oriented family therapists (Nichols & Schwartz, 1998. Family Therapy: Concepts and Methods. 4th ed. Allyn & Bacon). Bowen's therapy is an outgrowth of psychoanalytic theory and offers the most comprehensive view of human behavior and problems of any approach to family therapy. The core goal underlying the Bowenian model is differentiation of self, namely, the ability to remain oneself in the face of group influences, especially the intense influence of family life. The Bowenian model also considers the thoughts and feelings of each family member as well as the larger contextual network of family relationships that shapes the lie of the family. Bowen grew up in Waverly, Tennessee, the oldest child of a large cohesive family. After graduating from medical school and serving five years in the military, Bowen pursued a career in psychiatry. He began studying schizophrenia and his strong background in psychoanalytic training led him to expand his studies from individual patients to the relationship patterns between mother and child. From 1946 to 1954, Bowen studied the symbiotic relationships of mothers and their schizophrenic children at the Menninger Clinic in Topeka, Kansas. Here he developed the concepts of anxious and functional attachment to describe interactional patterns in the mother-child relationship. In 1954, Bowen became the first director of the Family Division at the National Institute of Mental Health (NIMH). He further broadened his attachment research to include fathers and developed the concept o triangulation as the central building block o relationship systems (Nichols & Schwartz, 1998. Family Therapy: Concepts and Methods. 4th ed. Allyn & Bacon). In his first year at NIMH, Bowen provided separate therapists for each individual member of a family, but soon discovered that this approach fractionated families instead of bringing them together. As a result, Bowen decided to treat the entire family as a unit, and became one of the founders of family therapy. In 1959, Bowen began a thirty-one year career at Georgetown University's Department of Psychiatry where he refined his model of family therapy and trained numerous students, including Phil Guerin, Michael Kerr, Betty Carter, and Monica McGoldrick, and gained international recognition for his leadership in the field of family therapy. He died in October 1990 following a lengthy illness.

Nathan Ackerman Nathan Ackerman's astute ability to understand the overall organization of families enabled him to look beyond the behavioral interactions of families and into the hearts and minds of each family member. He used his strong will and provocative style of intervening to uncover the family's defenses and allow their feelings, hopes, and desires to surface. Ackerman's training in the psychoanalytic model is evident in his contributions and theoretical approach to family therapy. Ackerman proposed that underneath the apparent unity of families there existed a wealth of intrapsychic conflict that divided family members into factions (Nichols & Schwartz, Family Therapy: Concepts and Methods. 4th ed. Allyn & Bacon 1998). Ackerman joined the Menninger Clinic in Topeka, Kansas, and became the chief psychiatrist of the Child Guidance Clinic in 1937. Initially, Ackerman followed the child guidance clinic model of having a psychiatrist treat the child and a social worker see the mother (Nichols & Schwartz, Family Therapy: Concepts and Methods. 4th ed. Allyn & Bacon 1998). However, within his first year of work at the clinic, Ackerman became a strong advocate of including the entire family when treating a disturbance in one of its members, and suggested that family therapy be used as the primary form of treatment in child guidance clinics (Nichols & Schwartz, 1998. Family Therapy: Concepts and Methods. 4th ed. Allyn & Bacon). Ackerman was committed to sharing his ideas and theoretical approach with other professionals in the field. In 1938 Ackerman published The Unity of the Family and Family Diagnosis: An Approach to the Preschool Child, both of which inspired the family therapy movement. Together with Don Jackson, Ackerman founded the first family therapy journal, Family Process, which is still the leading journal of ideas in the field today. In 1955 Ackerman organized the first discussion on family diagnosis at a meeting of the American Orthopsychiatric Association to facilitate communication in the developing field of family therapy. In 1957 Ackerman established the Family Mental Health Clinic in New York City and began teaching at Columbia University. He opened the Family Institute in 1960, which was later renamed the Ackerman Institute after his death in 1971.

Virginia Satir Virginia Satir is one of the key figures in the development of family therapy. She believed that a healthy family life involved an open and reciprocal sharing of affection, feelings, and love. Satir made enormous contributions to family therapy in her clinical practice and training. She began treating families in 1951 and established a training program for psychiatric residents at the Illinois State Psychiatric Institute in 1955. Satir served as the director of training at the Mental Research Institute in Palo Alto from 1959-66 and at the Esalen Institute in Big Sur beginning in 1966. In addition, Satir gave lectures and led workshops in experiential family therapy across the country. She was well-known for describing family roles, such as "the rescuer" or "the placator," that function to constrain relationships and interactions in families (Nichols & Schwartz, 1998. Family Therapy: Concepts and Methods. 4th ed. Allyn & Bacon). Satir's genuine warmth and caring was evident in her natural inclination to incorporate feelings and compassion in the therapeutic relationship. She believed that caring and acceptance were key elements in helping people face their fears and open up their hearts to others (Nichols & Schwartz, 1998. Family Therapy: Concepts and Methods. 4th ed. Allyn & Bacon). Above all other therapists, Satir's was the most powerful voice to wholeheartedly support the importance of love and nurturance as being the most important healing aspects of therapy. Unfortunately, Satir's beliefs went against the more scientific approach to family therapy accepted at that time, and she shifted her efforts away from the field to travel and lecture. Satir died in 1988 after suffering from pancreatic cancer.

Ivan Boszmormenyi-Nagy Ivan Boszmormenyi-Nagy's emphasis on loyalty, trust, and relational ethics -- both within the family and between the family and society -- made major contributions to the field of family therapy since its inception in the 1950's (Nichols & Schwartz, Family Therapy: Concepts and Methods. 4th ed. Allyn & Bacon 1998). A student of Virginia Satir and an accomplished scholar and clinician, Nagy was trained as a psychoanalyst and his work has encouraged many family therapists to incorporate psychoanalytic ideas with family therapy. Nagy is perhaps best known for developing the contextual approach to family therapy, which emphasizes the ethical dimension of family development. Based on the psychodynamic model, contextual therapy accentuates the need for ethical principles to be an integral part of the therapeutic process. Nagy believes that trust, loyalty, and mutual support are the key elements that underlie family relationships and hold families together, and that symptoms develop when a lack of caring and liability result in a breakdown of trust in relationships (Nichols & Schwartz, Family Therapy: Concepts and Methods. 4th ed. Allyn & Bacon 1998). The therapists' role is to help the family work through avoided emotional conflicts and to develop a sense of fairness among family members. In 1957, Nagy established the Eastern Pennsylvania Psychiatric Institute (EPPI) and served as codirector and cotherapist along with social worker Geraldine Spark. Nagy was also an active researcher of schizophrenia and family therapy and coauthored Invisible loyalties: Reciprocity in intergenerational family therapy (Boszormenyi-Nagy & Spark, 1973). Since the closing of EPPI, Nagy has continued to develop his contextual approach to family therapy and remains associated with Hahnemann University in Pennsylvania.

John Elderkin Bell Perhaps one of the first family therapists was John Elderkin Bell, who began treating families in the early 1950's. Bell's ingenious approach to family therapy involved developing a step-by-step, easy-to-follow plan of attack to treat family problems in stages. Bell's treatment approach was an outgrowth of group therapy and was aptly named family group therapy. In 1951 Bell discovered that John Bowlby, a well-respected clinician, was applying group psychotherapy techniques to treat individual families. Bell decided to follow Bowlby's approach, and did not discover until many years later that Bowlby had only used this treatment approach with one family. Bell believed that the treatment of families should follow a series of three stages designed to encourage communication among family members and to solve family problems. In the first stage, the child-centered phase, Bell encouraged children's involvement by facilitating the expression of their thoughts and feelings. In the parent-centered stage, parents responded to their children's concerns and often related difficulties they experienced with their children's behavior. The family-centered stage was the final phase of treatment, and Bell continued to stimulate communication among family members and to help solve family problems. Unfortunately, Bell's pioneering efforts in the field of family therapy are less well-known as compared to other family therapists. Bell did not publish his ideas until the 1960's, and he did not establish family therapy clinics or training centers.

Philip Guerin A student of Murray Bowen, Philip Guerin's own innovative ideas led to his developing a sophisticated clinical approach to treating problems of children and adolescents, couples, and individual adults (Nichols & Schwartz, 1998. Family Therapy: Concepts and Methods. 4th ed. Allyn & Bacon). Guerin's highly articulated model outlines several therapeutic goals, which emphasize the multigenerational context of families, working to calm the emotional level of family members, and defining specific patterns of relationships within families. Guerin's family systems approach is designed to measure the severity of conflict and to identify specific areas in need of improvement. In 1970 Guerin became the Director of Training of the Family Studies Section at Albert Einstein College of Medicine and Bronx State Hospital, a family therapy training center originally organized by Israel Zwerling and Marilyn Mendelsohn. Guerin's pioneering efforts and exceptional leadership resulted in his establishing an extramural training program in Westchester in 1972 and founding the Center for Family Learning in New Rochelle, New York, one of the most exceptional family therapy programs for training and practice in the nation (Nichols & Schwartz, 1998. Family Therapy: Concepts and Methods. 4th ed. Allyn & Bacon). In addition to being a distinguished clinician, Guerin has authored some of the most influential and valuable books and articles in the field of family therapy. Two of his best are: The Evaluation and treatment of marital conflict: A four-stage approach (Guerin, 1987) and Working with relationship triangles: The one-two-three of psychotherapy (Guerin, Fogarty, Fay & Kautto, 1996).

Don Jackson The vibrant and creative talent of Don Jackson contributred to his success as a writer, researcher, and cofounder of the leading journal in the field of family therapy, Family Process. A 1943 graduate of Stanford University School of Medicine, Jackson strongly rejected the psychoanalytic concepts that formed the basis of his early training. Instead, he focused his interest on Bateson's analysis of communication and behavior, which shaped his most important contributions to the developing field of family therapy. By 1954, Jackson had developed a rudimentary family interactional therapy out of his pioneering work with the Palo Alto group and research on schizophrenia (Nichols & Schwartz, 1998. Family Therapy: Concepts and Methods. 4th ed. Allyn & Bacon). Jackson observed the mutual impact of schizophrenic patients and their families in the home environment, and quickly recognized the importance of treating the family unit instead of removing patients for individual treatment. His early work centered on the effects of patients' therapy on the entire family, and he developed the concept of family homeostasis to describe how families resist change and seek to maintain redundant patterns of behavior. Jackson also suggested that family members react to schizophrenic members' symptoms in ways that serve to stabilize the family's status quo and often result in inflexible ways of thinking and maintain the symptomatic behavior (Nichols & Schwartz, 1998. Family Therapy: Concepts and Methods. 4th ed. Allyn & Bacon). In 1958, Jackson established the Mental Research Institute and worked with Virginia Satir, Jules Riskin, Jay Haley, John Weakland, Paul Watzlawick and Bateson. By 1963, Jackson's model of the family involved several types of rules that defined the communication patterns and interactions among family members. Jackson believed that family dysfunction was a result of a family's lack of rules for change, and that the therapist's role was to make the rules explicit and to reconstruct rigid which maintained family problems. In 1968, tragically Jackson died by his own hand at the age of 48.

Carl Whitaker Carl Whitaker's creative and spontaneous thinking formed the basis of a bold and inventive approach to family therapy. He believed that active and forceful personal involvement and caring of the therapist was the best way to bring about changes in families and promote flexibility among family members. He relied on his own personality and wisdom, rather than any fixed techniques, to stir things up in families and to help family members open up and be more fully themselves (Nichols & Schwartz, 1998. Family Therapy: Concepts and Methods. 4th ed. Allyn & Bacon). Whitaker's confrontive approach earned him the reputation as the most irreverent among family therapy's iconoclasts. Whitaker viewed the family as an integrated whole, not as a collection of discrete individuals, and felt that a lack of emotional closeness and sharing among family members resulted in the symptoms and interpersonal problems that led families to seek treatment. He equated familial togetherness and cohesion with personal growth, and emphasized the importance of including extended family members, especially the expressive and playful spontaneity of children, in treatment. A big, comfortable, lantern-jawed man, Whitaker liked a crowd in the room when he did therapy. Whitaker also pioneered the use of cotherapists as a means of maintaining objectivity while using his highly provocative techniques

to turn up the emotional temperature of families (Nichols & Schwartz, 1998. Family Therapy: Concepts and Methods. 4th ed. Allyn & Bacon). Beginning in 1946, Whitaker served as Chairman of the Department of Psychiatry at Emory University, where he focused on treating schizophrenics and their families. He also helped to develop some of the first major professional meetings of family therapists with colleagues such as John Warkentin, Thomas Malone, John Rosen, Bateson, and Jackson. In 1955, Whitaker left Emory to enter into private practice, and became a professor of Psychiatry at the University of Wisconsin in 1965 until his retirement in 1982. Whitaker died in April 1995, leaving a heartfelt void in the field of family therapy.

Betty Carter An ardent and articulate feminist, Betty Carter was instrumental in enriching and popularizing the concept of the family life cycle and its value in assessing families. Carter entered the field of family therapy after being trained as a social worker, and emphasized the importance of historical antecedents of family problems and the multigenerational aspects of the life cycle that extended beyond the nuclear family. Carter further expanded on the family life cycle concept by considering the stages of divorce and remarriage (Nichols & Schwartz, 1998. Family Therapy: Concepts and Methods. 4th ed. Allyn & Bacon). Carter's interest in family therapy was stimulated by taking part in a family therapy field placement at the Ackerman Institute as part of her M.S.W. requirements at Hunter College. She quickly became an avid student of the Bowenian model, and served on the staff of the Family Studies Section at Albert Einstein College of Medicine and Bronx State Hospital with Phil Guerin and Monica McGoldrick. Carter left the Center for Family Learning to become the founding director of the Family Institute of Westchester in 1977. Carter served as Codirector of the Women's Project in Family Therapy with Peggy Papp, Olga Silverstein, and Marianne Walters, and has been an outspoken leader about the gender and ethnic inequalities that serve to keep women in inflexible family roles. Currently, Carter is an active clinician and specializes in marital therapy and therapy with remarried couples (Nichols & Schwartz, 1998. Family Therapy: Concepts and Methods. 4th ed. Allyn & Bacon). Her work with couples focuses on helping her clients to understand their situation and to address unresolved family issues. Carter incorporates tasks, such as letter writing, which serve to intensify and speed up the communication process and help couples move out of rigid patterns of behavior.

Michael White Michael White, the guiding genius of narrative family theapy, began his professional life as a mechanical draftsman. But he soon realized that he preferred people to machines and went into social work where he gravitated to family therapy. Following an initial attraction to the cybernetic thinking of Gregory Bateson, White became more interested in the ways people construct meaning in their lives than just with the ways they behaved. In developing the notion that people's lives are organized by their life narratives, White came to believe that stories don't mirror life, they shape it. That's why people have the interesting habit of becoming the stories they tell about their experience. Narrative therapists break the grip of unhelpful stories by externalizing problmes. By challenging fixed and pessimistic versions of events, therapists make room for fliexibility and which new and more optimistic stories can be envisioned. Finally, clients are encouraged to create audiences of support to witness and promote their progress in restoring their lives along preferred lines. White's innovative thinking helped shape the basic tenets of narrative therapy, which considers the broader historical, cultural and political framework of the family. In the narrative approach, therapists try to understand how clients' personal beliefs and perceptions, or narratives, shape their self-concept and personal relationships. Individual clients of families are then encouraged to reconstruct their narratives to facilitate more adaptive views of themselves and more effective interpersonal interactions. White's leadership of the narrative movement in family therapy is based not only on his imaginative ideas but also on his inspriational persistence in seeing the best in people even when they've lost faith in themselves. White is well-known for his persistence in challenging clients' negative self-beliefs and for his relentless optimism in helping people to develop healthier interpretations of their life experiences. White's tenaciously positive attitude has undoubtably contributed to his enormous success as a therapist. Currently, White lives in Adelaide, South Australia. Together with his wife, Cheryl, White works at the Dulwich Centre, a training and clinical facility that also publishes the Dulwich Newsletter, which White uses to explore his ideas with the field.

MODELS AND SCHOOLS Family therapists and counselors use a range of methods and over the years a number of models or schools of family therapy have developed. A well-known classification of these approaches is described by Gurman and Kniskern (1991): 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11.

Behavioural Family Therapy Bowen theory Brief Therapy: MRI Contextual Therapy Eriscksonian Family Therapy Focal Family Therapy Milan Systemic Therapy Family Psychoeducational Therapy Strategic Therapy Structural Therapy Symbolic-Experiential Therapy

Some contemporary family therapies: Structural Family Therapy (Minuchin, 1974, Colapinto, 1991) In this type of therapy, the structural therapist believes that change of behaviour is most important. Therapy begins with the therapist “joining” with the family. He or she has the purpose to enhance the feeling of worth of individual family members. The therapist must attune himself or herself to the families value systems and existing hierarchies. After “joining”, the therapist challenges “how things are done“ and begins restructuring the family by offering alternative, more functional ways of behaving. Conjoint Family Therapy (Satir, 1967) Conjoint family therapy works with personal experiences and helps experiencing the value of the individual within the family system. Therapists use all levels of communication to express the relational qualities present in the family to achieve change in family system. This approach uses many feeling and communication exercises and games, for example family sculpture. Contextual Therapy (Boszormenyi-Nagy, 1991) In the contextual approach the word “context“ indicates the dynamic connectedness of a person with her or his significant relationships, the long-term relational involvement as well as the person’s relatedness to his or her multigenerational roots. The therapist encourages family members to explore their own multilaterality. Strategic Therapy (Madanes, 1981) In this approach, the therapist considers the therapy in terms of step-by-step change in the way from one type of abnormal organisation to another type before a more normal organisation is finally achieved. For a strategic therapist two questions are basic: How is the symptom “helping” the family to maintain a balance or overcome a crisis? How can the symptom be replaced by a more effective solution of the problem?

Brief Therapy This name refers not only to the duration of the therapy, but it represents comprehensively a way of orientation in therapeutic practice. Problem formation and maintenance is seen as parts if vicious-circle process, in which maladaptive “solutions“ behaviours maintain the problem. Alteration of these behaviours /or beliefs/ should interrupt the cycle and initiate the resolution of the problem. Milan Systemic Therapy (Boscolo et al, 1987) Basic assumption of Milan Systemic Therapy is that mind is social. The symptomatic behaviour is conceived as a part of the transactional patterns of the system. Significance of any particular behaviour or event may be derived from its social context. The therapists consider that the way to eliminate the symptom which is present in the family is to change the rules and beliefs. Change is achieved in clarifying the ambiguity in relationships. Narrative Therapy (Freedman, Combs, 1996) The followers of the narrative approach consider that experience rooted in the life events is elaborated in the form of a story, which gives to these events a meaning reflecting the systems of belief. In the therapy process, the “life story” of a family is connected with the internal and external culture of the family. Change is enabled by retelling the story, in the course of which meanings attributed to the events can change or alternate. http://www.dmrtk.jgytf.u-szeged.hu/phare/eng/more.htm

Academic resources • • • • • • • • • • • • •

Family Process Journal of Child and Family Studies, ISSN: 1062-1024 (Print) 1573-2843 (Online), Springer Journal of Marital and Family Therapy Journal of Family Psychology Family Relations Contemporary Family Therapy Australian & New Zealand Journal of Family Therapy Family Matters, Australian Institute of Family Studies Journal of Comparative Family Studies, ASIN: B00007M2W5, Univ of Calgary/Dept Sociology Journal of Family Studies, ISSN: 1322-9400, eContent Management Pty Ltd [1] Journal of Family Therapy, AFT (Association for family Therapy & Systemic Practice in the UK) [2] Context Magazine, AFT, UK [3] Karnac Systemic Thinking and Practice Series

Professional Organizations • • • • • •

American Association for Marriage and Family Therapy American Family Therapy Academy European Family Therapy Association (EFTA) International Association of Marriage and Family Counsellors National Council on Family Relations The Ackerman Institute for the Family

See also • • • • • • • • •

Alternative dispute resolution CAMFT Child abuse Conflict resolution Deinstitutionalisation Domestic violence Dysfunctional family Family Life Education Family Life Space

• • • • • • • •

Internal Family Systems Model Interpersonal psychotherapy Interpersonal relationship Mediation Multisystemic Therapy (MST) Positive psychology Relationships Australia Strategic Family Therapy

References 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21. 22. 23. 24.

^ a b c Broderick, C.B. & Schrader, S.S. (1991). The History of Professional Marriage and Family Therapy. In A. S. Gurman & D. P. Kniskern (Eds.), Handbook of Family Therapy. Vol. 2. NY: Brunner/Mazel ^ a b c d e Sholevar, G.P. (2003). Family Theory and Therapy. In Sholevar, G.P. & Schwoeri, L.D. Textbook of Family and Couples Therapy: Clinical Applications. Washington, DC: American Psychiatric Publishing Inc. ^ Silverman, M. & Silverman, M. Psychiatry Inside the Family Circle. Saturday Evening Post, 46-51. 28 July 1962. ^ Guttman, H.A. (1991). Systems Theory, Cybernetics, and Epistemology. In A. S. Gurman & D. P. Kniskern (Eds.), Handbook of Family Therapy. Vol. 2. NY: Brunner/Mazel ^ Becvar, D.S., & Becvar, R.J. (2008). Family therapy: A systemic integration. 7th ed. Boston: Allyn & Bacon. ^ a b Barker, P. (2007). Basic family therapy; 5th edition. Wiley-Blackwell. ^ a b Nichols, M.P. & Schwartz, R.C. (2006). Family therapy: concepts and methods. 7th ed. Boston: Pearson/Allyn & Bacon. ^ Sprenkle, D.H., & Bischof, G.P. (1994). Contemporary family therapy in the United States. Journal of Family Therapy, 16(1): 5-23(19) ^ Dattilio, F.R. (Ed.) (1998). Case Studies in Couple and Family Therapy: Systemic and Cognitive Perspectives. Guildford Press: New York. ^ Gurman, A.S. & Fraenkel, P. (2002). The history of couple therapy: a millennial review. Family Process, 41(2): 199-260(62) ^ Couple therapy Harvard Mental Health Letter 03/01/2007. ^ Attachment and Family Systems. Family Process. Special Issue: Fall 2002 41(3) ^ Denborough, D. (2001). Family Therapy: Exploring the Field's Past, Present and Possible Futures. Adelaide, South Australia: Dulwich Centre Publications. ^ Crago, H. (2006). Couple, Family and Group Work: First Steps in Interpersonal Intervention. Maidenhead, Berkshire; New York: Open University Press. ^ Van Buren, J. Multisystemic therapy. Encyclopedia of Mental Disorders. retrieved 29 Oct. 2009 ^ McGoldrick, M. (Ed.) (1998). Re-Visioning Family Therapy: Race, Culture, and Gender in Clinical Practice. Guilford Press: New York. ^ Dean, R.G. (2001). The Myth of Cross-Cultural Competence. Families in Society: The Journal of Contemporary Human Services. 82(6): 623-30. ^ Krause, I-B. (2002). Culture and System in Family Therapy. London; New York: Karnac. ^ Ng, K.S. (2003). Global Perspectives in Family Therapy: Development, Practice, and Trends. New York: BrunnerRoutledge. ^ McGoldrick, M., Giordano, J. & Garcia-Preto, N. (2005). Ethnicity & Family Therapy, 3rd Ed.: Guilford Press. ^ Nichols, M.P. & Schwartz, R.C. (2006). Recent Developments in Family Therapy: Integrative Models; in Family therapy: concepts and methods. 7th ed. Boston: Pearson/Allyn & Bacon. ^ Lebow, J. (2005). Handbook of clinical family therapy. Hoboken, NJ: John Wiley and Sons. ^ Booth, T.J. & Cottone, R.R. (2000). Measurement, Classification, and Prediction of Paradigm Adherence of Marriage and Family Therapists. American Journal of Family Therapy. 28(4): 329-346. ^ The Top 10: The Most Influential Therapists of the Past Quarter-Century. Psychotherapy Networker.: 2007, March/April (retrieved 7 Oct 2010)

25. ^ "Therapy Center:Credentials". Psychology Today. Retrieved 2008-08-13. 26. ^ Doherty W (2002). "Bad Couples Therapy and How to Avoid It: Getting past the myth of therapist neutrality". Psychotherapy Networker 26 (Nov-Dec): 26–33. 27. ^ Doherty, W., & Boss, P. (1991). Values and ethics in family therapy. In A. S. Gurman & D. P. Kniskern (Eds.), Handbook of Family Therapy. Vol. 2. NY: Brunner/Mazel 28. ^ Dueck A (1991). "Metaphors, models, paradigms and stories in family therapy". In Vande Kemp H. Family therapy: Christian perspectives. Grand Rapids, MI: Baker Book House. pp. 175–207. ISBN 0-8010-9313-9. 29. ^ Wall J, Needham T, Browning DS, James S (Apr 1999). "The Ethics of Relationality: The Moral Views of Therapists Engaged in Marital and Family Therapy". Family Relations (National Council on Family Relations) 48 (2): 139–49. doi:10.2307/585077. JSTOR 585077. 30. ^ Grosser GH, Paul NL (Oct 1964). "Ethical issues in family group therapy". Am J Orthopsychiatry 34 (5): 875–84. doi:10.1111/j.1939-0025.1964.tb02243.x. PMID 14220517. 31. ^ Hare-Mustin RT (Jun 1978). "A feminist approach to family therapy". Fam Process 17 (2): 181–94. doi:10.1111/j.1545-5300.1978.00181.x?journalCode=famp. PMID 678351. 32. ^ Gottlieb, M.C. (1995). Developing Your Ethical Position in Family Therapy: Special Issues. Paper presented at the Annual Meeting of the American Psychological Association (103rd, New York, NY, August 11–15, 1995). 33. ^ Melito, R. (2003). Values in the role of the family therapist: Self determination and justice. Journal of Marital and Family Therapy. 29(1):3-11. 34. ^ Fowers BJ, Richardson FC (1996). "Individualism, Family Ideology and Family Therapy". Theory & Psychology 6 (1): 121–51. doi:10.1177/0959354396061009. 35. ^ USA Today 6/21/2005 Hearts divide over marital therapy. 36. ^ Gehart, D. R., & Tuttle, A. R. (2003). Theory-based treatment planning for marriage and family therapists: Integrating theory and practice. Pacific Grove, CA: Brooks/Cole/Thomson. 37. ^ Goldenberg, I., & Goldenberg, H. (2008). Family therapy: An overview. Belmont, CA: Thomson Brooks/Cole. 38. ^ Gurman, A. S. (2008). Clinical handbook of couple therapy. New York: Guilford Press. 39. ^ a b Sexton, T. L., Weeks, G. R., & Robbins, M. S. (2003). Handbook of family therapy: The science and practice of working with families and couples. New York: Brunner-Routledge.

External links Included in this list are the main professional associations in the US and internationally; they reflect to some degree the different theoretical, ideological, and cross-cultural views of family therapy theory and practice. • • • • • • • • • • • • • • • •

American Association for Marriage and Family Therapy: main professional association in US American Family Therapy Academy: main research-oriented professional association in US Association for Family Therapy and Systemic Practice in the UK Australian and New Zealand Journal of Family Therapy: the de facto professional association for Australia and NZ Bowen Theory from the Bowen Center for the Study of the Family. California Association of Marriage and Family Therapists European Family Therapy Association International Family Therapy Association Historical overview of the field; Therapist profiles; Timeline from Allyn and Bacon/Longman publishing. Family Support Partnership - An Overview of Family Therapy and Mediation Dulwich Centre: Gateway to Narrative Therapy & Community Work [4] "Mind For Therapy" group devoted to creative origins of Family Therapy Glossary of Family Systems and intergenerational concepts MFT at Notre Dame de Namur University, Belmont CA Social Construction Therapies Network

Brief Strategic Family Therapy The family is defined by an organizational structure that is characterized by degrees of cohesiveness, love, loyalty, and purpose as well as high levels of shared values, interests, activities, and attention to the needs of its members. Families may be considered a system, organized wholes or units made up of several interdependent and interacting parts. Each member has a significant influence on all other members. For positive change in an identified client, therefore, family members have to change the way they interact. Family therapists work with the present relationships rather than the past. They are interested in the balance families maintain between bipolar extremes that characterize dysfunctional families. Strategic refers to the development of a specific strategy, planned in advance by the therapist, to resolve the presenting problem as quickly and efficiently as possible. DESCRIPTION Brief Strategic Family Therapy (BSFT) is a short-term, problem-focused therapeutic intervention, targeting children and adolescents 6 to 17 years old, that improves youth behaviour by eliminating or reducing drug use and its associated behaviour problems and that changes the family members’ behaviours that are linked to both risk and protective factors related to substance abuse. The therapeutic process uses techniques of: Joining—forming a therapeutic alliance with all family members Diagnosis—identifying interactional patterns that allow or encourage problematic youth behaviour Restructuring—the process of changing the family interactions that are directly related to problem behaviours PROGRAM BACKGROUND BSFT was developed at the Spanish Family Guidance Center in the Center for Family Studies, University of Miami. BSFT has been conducted at these centers since 1975. The Center for Family Studies is the Nation’s oldest and most prominent center for development and testing of minority family therapy interventions for prevention and treatment of adolescent substance abuse and related behaviour problems. It is also the Nation’s leading trainer of research-proven, family therapy for Hispanic/Latino families. INDICATED This program was developed for an indicated audience. It targets children with conduct problems, substance use, problematic family relations, and association with antisocial peers. CONTENT FOCUS ALCOHOL, ANTISOCIAL/AGGRESSIVE BEHAVIOUR, ILLEGAL DRUGS, SOCIAL AND EMOTIONAL COMPETENCE, TOBACCO This program addresses family risk and protective factors to problem behaviour, including substance use among adolescents. Parents as a primary target population: The program involves family systems therapy, involving all family members. It seeks to change the way family members act toward each other so that they will promote each other’s mastery over behaviours that are required for the family to achieve competence and to impede undesired behaviours. INTERVENTIONS BY DOMAIN INDIVIDUAL: Life and social skills training FAMILY : Home visits, Parent education/family therapy, Parent education/parenting skills training Task-oriented family education sessions combining social skills training to improve family interaction (e.g., communication skills) PEER : Peer-resistance education

KEY PROGRAM APPROACHES PARENT-CHILD INTERACTIONS : All of the key strategies are focused on improving the interactions between parents and child. PARENT TRAINING : A key change strategy is to empower parents by increasing their mastery of parenting skills. SKILL DEVELOPMENT : The program fosters conflict resolution skills, parenting skills, and communication skills. TECHNIQUES USED • • •

Joining—forming a therapeutic alliance with all family members Diagnosis—identifying interactional patterns that allow or encourage problematic youth behaviour Restructuring—the process of changing the family interactions that are directly related to problem behaviours

THERAPY The program involves creating a counsellor-family work team that develops a therapeutic alliance with each family member and with the family as a whole; diagnosing family strengths and problematic interactions; developing change strategies to capitalize on strengths and correct problematic family interactions; and implementing change strategies and reinforcing family behaviours that sustain new levels of family competence. Strategies include reframing, changing alliances, building conflict resolution skills, and parental empowerment. HOW IT WORKS BSFT can be implemented in a variety of settings, including community social services agencies, mental health clinics, health agencies, and family clinics. BSFT is delivered in 8 to 12 weekly 1- to 1.5-hour sessions. The family and BSFT counsellor meet either in the program office or the family’s home. Sessions may occur more frequently around crises because these are opportunities for change. There are four important BSFT steps: Step 1: Organize a counsellor-family work team. Development of a therapeutic alliance with each family member and with the family as a whole is essential for BSFT. This requires counsellors to accept and demonstrate respect for each individual family member and the family as a whole. Step 2: Diagnose family strengths and problem relations. Emphasis is on family relations that are supportive and problem relations that affect youths’ behaviours or interfere with parental figures’ ability to correct those behaviours. Step 3: Develop a change strategy to capitalize on strengths and correct problematic family relations, thereby increasing family competence. In BSFT, the counsellor is plan- and problem-focused, directionoriented (i.e., moving from problematic to competent interactions), and practical. Step 4: Implement change strategies and reinforce family behaviours that sustain new levels of family competence. Important change strategies include reframing to change the meaning of interactions; changing alliances and shifting interpersonal boundaries; building conflict resolution skills; and providing parenting guidance and coaching. BARRIERS AND PROBLEMS Problem: The most common problem is engaging and retaining whole families in treatment. Solution: Specialized engagement strategies have been developed to deal with the problem. Problem: A common problem in implementing a whole-family intervention involves limited availability of family members. Solution: Sessions often must occur during evening hours and on weekends.

Strategic Family Therapy Strategic family therapy is a family-oriented therapy that involves a patient's daily family environment as a major part of treatment. Pressure from family, society and peers can create rifts in even the strongest families creating dysfunction. The goal is to fix the problem creating disruption and preserving the family unit no matter what. Strategic Family Therapy (Madanes and Haley) designs a strategy for each specific problem. Clear goals set, symptoms deprived of their relationship-controlling function. Therapist controls the therapy. Every interaction is a struggle for control of the relationship's definition. Symmetrical (similar, often competitive) vs. complementary (different, often counterresponding) interactions. Metacommunication and repetitive interactions examined. Prescriptive and descriptive paradoxical assignments. Madanes: "pretend techniques." Circular questioning. Positive connotation (as reframe of symptomatic behaviour). Haley Model Jay Haley and Salvador Minuchin are considered the pioneers of strategic family therapy. In the 1950s and 1960s, Haley and other therapists began experimenting with alternative models of working with families that relied on solution-focused techniques. The solution-focused approach was favored over traditional psychoanalysis. The therapy is based on the idea that people don't develop problems in isolation. Strategic therapy implements techniques that meet the specific need of a family and their interaction. Behavior Problems Children between the ages eight and 17 are vulnerable to developing behavior problems. When this happens it can throw family dynamics into a state of chaos. Strategic family therapy is a solution-oriented approach. They focus on getting to the root of the problem rather than what caused it. The therapist works on helping their clients turn their lives around by creating a carefully planned strategy, execution and monitoring progress. The therapy is based on five stages: identify problems that can be solved, establish goals, create interventions that meet these objectives, analyze the responses, and examine the results. The therapy emphasis is on the social situation not the individual. Solving problems, meeting family goals and help change a person's dysfunctional behavior. Family Interaction Strategic family therapy considers the family unit as a system. Families function just like any other system. They naturally establish rules and interactions that affect every member. When the affected family member's problems are recognized and addressed, the entire family becomes part of the solution process. The idea behind this method is that the family has the most influence on a person's life. Therapy All the family members participate within a safe, therapeutic setting. The therapist attempts to recreate typical family interactions and conversation through provocative questioning techniques so that the problems can be presented and addressed accordingly. It also give family members a chance to see how their interactions and responses can contribute to a dysfunctional situation. The therapy works on helping families discover their unique ability to solve their problems using internal resources they weren't aware they had. Who Does it Help? All families face challenges. ADD/ADHD, depression and substance abuse are a few of examples of issues that can affect a family unit. If a child were dealing with any of the previous issues and had become estranged from the family, the therapist would bring everyone together in a clinical setting to watch how they interact. Then he could work closely with everyone in the family to implement and execute solutions to help correct the dysfunctional behavior.

Solution focused brief therapy From Wikipedia, the free encyclopedia Solution focused brief therapy (SFBT), often referred to as simply 'solution focused therapy' or 'brief therapy', is a type of talking therapy that is based upon social constructionist philosophy. It focuses on what clients want to achieve through therapy rather than on the problem(s) that made them to seek help. The approach does not focus on the past, but instead, focuses on the present and future. The therapist/counsellor uses respectful curiosity to invite the client to envision their preferred future and then therapist and client start attending to any moves towards it whether these are small increments or large changes. To support this, questions are asked about the client’s story, strengths and resources, and about exceptions to the problem. Solution focused therapists believe that change is constant. By helping people identify the things that they wish to have changed in their life and also to attend to those things that are currently happening that they wish to continue to have happen, SFBT therapists help their clients to construct a concrete vision of a preferred future for themselves. The SFBT therapist then helps the client to identify times in their current life that are closer to this future, and examines what is different on these occasions. By bringing these small successes to their awareness, and helping them to repeat these successful things they do when the problem is not there or less severe, the therapists helps the client move towards the preferred future they have identified. Solution focused work can be seen as a way of working that focuses exclusively or predominantly at two things. 1) Supporting people to explore their preferred futures. 2) Exploring when, where, with whom and how pieces of that preferred future are already happening. While this is often done using a social constructionist perspective the approach is practical and can be achieved with no specific theoretical framework beyond the intention to keep as close as possible to these two things.

Contents • • • • • • •

1 Basic Principles 2 Questions 3 Resources 4 History of Solution Focused Brief Therapy 5 Solution-Focused counselling 6 Solution-Focused consulting 7 References

Basic Principles: Clients have resources and strengths to resolve complaints — It is therapist’s task to access these abilities and help clients put them to use. Change is constant — Therapists can do a great deal to influence client’s perceptions regarding the inevitability of change and what is supposed to happen during the therapy session.

The therapist’s job is to identify and amplify change — He/She accomplishes this through choice of questions, topics focused on or ignored. “Focus on what seems to be working however small, to label it as worthwhile, and to work toward amplifying it.” If [the change] is in a crucial area, it can change the whole system. It is usually unnecessary to know a great deal about the complaint in order to resolve it — What is significant is what the clients are doing that is working. Learn from clients’ identifying when the problem is not troublesome. Clients can learn to function that way again to solve the problem. It is not necessary to know the cause or function of a complaint to resolve it — Even the most creative hypotheses about the possible function of a symptom will not offer therapists a clue about how people can change. It simply suggests how people’s lives have become static. Ask those who want to know why they have a symptom: “Would it be enough if the problem were to disappear and you never understood why had it?” A small change is all that is necessary: A change in one part of the system can affect change in another part of the system — “We have the sense that positive changes will at least continue and may expand and have beneficial effects in other areas of the person’s life. Clients define the goal — Do not assume that therapists are better equipped to decide how their clients should live their lives; ask people to establish their own goals for treatment. Rapid change or resolution of problems is possible — “We believe that, as a result of our interaction during the first session, our clients will gain a more productive and optimistic view of their situations.” Therapists expect them to go home and do what is necessary to make their lives more satisfying (p. 45). Average length of treatment is less than 10 sessions, usually 4 to 5, occasionally only 1. There is no one “right” way to view things; Different views may be just as valid and may fit the facts just as well — Views that keep people stuck are simply not useful. Sometimes all that is necessary to initiate significant change is a shift in the person’s perception of the situation.” Focus on what is possible and changeable rather than what is impossible and intractable — Focus on aspects of a person’s situation that seem most changeable. This imparts a sense of hope and power

Questions The miracle question The miracle question is a method of questioning that a coach, therapist, or counsellor uses to aid the client to envision how the future will be different when the problem is no longer present. Also, this may help to establish goals. A traditional version of the miracle question would go like this: "Suppose our meeting is over, you go home, do whatever you planned to do for the rest of the day. And then, some time in the evening, you get tired and go to sleep. And in the middle of the night, when you are fast asleep, a miracle happens and all the problems that brought you here today are solved just like that. But since the miracle happened overnight nobody is telling you that the miracle happened. When you wake up the next morning, how are you going to start discovering that the miracle happened? ... What else are you going to notice? What else?" Whilst relatively easy to state the miracle question requires considerable skill to ask well. The question must be asked slowly with close attention to the person's non-verbal communication to ensure that the pace matches the person's ability to follow the question. Initial responses frequently include a sense of "I don't know." To ask the question well this should be met with respectful silence to give the person time to fully absorb the question.

Once the miracle day has been thoroughly explored the worker can follow this with scales, on a scale where 0 = worst things have ever been and 10 = the miracle day where are you now? Where would it need to be for you to know that you didn't need to see me any more? What will be the first things that will let you know you are 1 point higher. In this way the miracle question is not so much a question as a series of questions. There are many different versions of the miracle question depending on the context and the client. In a specific situation, the counsellor may ask, "If you woke up tomorrow, and a miracle happened so that you no longer easily lost your temper, what would you see differently?" What would the first signs be that the miracle occurred?" The client (a child) may respond by saying, "I would not get upset when somebody calls me names." The counsellor wants the client to develop positive goals, or what they will do, rather than what they will not do--to better ensure success. So, the counsellor may ask the client, "What will you be doing instead when someone calls you names?" Scaling Questions Scaling questions are tools that are used to identify useful differences for the client and may help to establish goals as well. The poles of a scale can be defined in a bespoke way each time the question is asked, but typically range from "the worst the problem has ever been" (zero or one) to "the best things could ever possibly be" (ten). The client is asked to rate their current position on the scale, and questions are then used to help the client identify resources (e.g. "what's stopping you from slipping one point lower down the scale?"), exceptions (e.g. "on a day when you are one point higher on the scale, what would tell you that it was a 'one point higher' day?") and to describe a preferred future (e.g. "where on the scale would be good enough? What would a day at that point on the scale look like?") Exception Seeking Questions Proponents of SFBT insist that there are always times when the problem is less severe or absent for the client. The counsellor seeks to encourage the client to describe what different circumstances exist in that case, or what the client did differently. The goal is for the client to repeat what has worked in the past, and to help them gain confidence in making improvements for the future. Coping questions Coping questions are designed to elicit information about client resources that will have gone unnoticed by them. Even the most hopeless story has within it examples of coping that can be drawn out: "I can see that things have been really difficult for you, yet I am struck by the fact that, even so, you manage to get up each morning and do everything necessary to get the kids off to school. How do you do that?" Genuine curiosity and admiration can help to highlight strengths without appearing to contradict the clients view of reality. The initial summary "I can see that things have been really difficult for you" is for them true and validates their story. The second part "you manage to get up each morning etc.", is also a truism, but one that counters the problem focused narrative. Undeniably, they cope and coping questions start to gently and supportively challenge the problemfocused narrative. Problem-free talk In solution-focused therapy, problem-free talk can be a useful technique for identifying resources to help the person relax, or be more assertive, for example. Solution focused therapists will talk about seemingly irrelevant life experiences such as leisure activities, meeting with friends, relaxing and managing conflict. The therapist can also gather information on the client's values and beliefs and their strengths. From this discussion the therapist can use these strengths and resources to move the therapy forward. For example; if a client wants to be more assertive it may be that under certain life situations they are assertive. This strength from one part of their life can then be transferred to the area with the current problem. Or if a client is struggling with their child because the child gets aggressive and calls the parent names and the parent continually retaliates and also gets angry, then perhaps they have an area of their life where they remain calm even under pressure; or maybe they have

trained a dog successfully that now behaves and can identify that it was the way they spoke to the dog that made the difference and if they put boundaries in place using the same firm tonality the child might listen. Dan Jones, in his Becoming a Brief Therapist book writes: '...it is in the problem free areas you find most of the resources to help the client. It also relaxes them and helps build rapport, and it can give you ideas to use for treatment...Everybody has natural resources that can be utilised. These might be events...or talk about friends or family...The idea behind accessing resources is that it gives you something to work with that you can use to help the client to achieve their goal...Even negative beliefs and opinions can be utilised as resources ' [1]

Resources A key task in SFBT is to help clients identify and attend to their skills, abilities, and external resources (e.g. social networks). This process not only helps to construct a narrative of the client as a competent individual, but also aims to help the client identify new ways of bringing these resources to bear upon the problem. Resources can be identified by the client and the worker will achieve this by empowering the client to identify their own resources through use of scaling questions, problem-free talk, or during exception-seeking. Resources can be Internal: the client's skills, strengths, qualities, beliefs that are useful to them and their capacities. Or, External: Supportive relationships such as, partners, family, friends, faith or religious groups and also support groups.

History of Solution Focused Brief Therapy Solution Focused Brief Therapy is one of a family of approaches, known as systems therapies, that have been developed over the past 50 years or so, first in the USA, and eventually evolving around the world, including Europe. The title SFBT, and the specific steps involved in its practice, are attributed to husband and wife Steve de Shazer and Insoo Kim Berg and their team at the Brief Family Therapy Center in Milwaukee, USA. Core members of this team were Eve Lipchik, Wallace Gingerich, Elam Nunnally, Alex Molnar, and Michele Weiner-Davis. Their work in the early 1980s built on that of a number of other innovators, among them Milton Erickson, and the group at the Mental Research Institute at Palo Alto â&#x20AC;&#x201C; Gregory Bateson, Donald deAvila Jackson, Paul Watzlawick, John Weakland, Virginia Satir, Jay Haley, Richard Fisch, Janet Beavin Bavelas and others. The concept of brief therapy was independently discovered by several therapists in their own practices over several decades (notably Milton Erickson), was described by authors such as Haley in the 1950s, and became popularized in the 1960s and 1970s. Richard Bandler, John Grinder and Stephen R Lankton have also been credited, at least in part, with the inspiration for and popularization of brief therapy, particularly through their work with Milton Erickson.[2] While Jay Hayley and the team at the Mental Research Institute at Palo Alto aimed to uncover the principles that underpinned Erickson's approach to brief therapy, John Grinder and Richard Bandler provided practical guidelines for the application of some of the hypnotic techniques of Erickson.[3][4] Solution Focused Brief Therapy has branched out in numerous spectrums - indeed, the approach is now known in other fields as simply Solution Focus or Solutions Focus. Most notably, the field of Addiction Counselling has begun to utilize SFBT as an effective means to treat problem drinking. The Center for Solutions in Cando, ND has implemented SFBT as part of their program, wherein they utilize this therapy as part of a partial hospitalization and residential treatment facility for both adolescents and adults.

Solution-Focused counselling Solution-Focused counselling is a solution focused brief therapy model. Various similar, yet distinct, models have been referred to as solution-focused counselling. For example, Jeffrey Guterman developed a solution-focused approach to counselling in the 1990s. This model is an integration of solution-focused principles and techniques, postmodern theories, and a strategic approach to eclecticism.

Solution-Focused consulting Solution-Focused consulting is an approach to organizational change management that is built upon the principles and practices of Solution-Focused therapy. While therapy is for individuals and families, Solution-Focused consulting is being used as a change process for organizational groups of every size, from small teams to large business units.

References •

^ Jones, Dan Becoming a Brief Therapist: Special Edition The Complete Works, Lulu.com, 2008, page 451, ISBN 1-40923031-7

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^ See page 671 in Steenbarger (2002) "Single-session therapy: Theoretical underpinnings" In Elsevier Encyclopedia of Psychotherapy

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^ (Shazer 1982 p.22)

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^ Shazer, SD. (1982) Patterns of brief family therapy: an ecosystemic approach. Guilford Press.

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I.K.Berg and S.deShazer: Making numbers talk: Language in therapy. In S. Friedman (Ed.), "The new language of change:

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Constructive collaboration in psychotherapy." New York:Guilford, 1993.

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I.K.Berg, "Family based services: A solution-focused approach." New York:Norton. 1994.

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I.K.Berg; "Solution-Focused Therapy: An Interview with Insoo Kim Berg." Psychotherapy.net, 2003.

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B.Cade and W.H. O’Hanlon: A Brief Guide to Brief Therapy. W.W. Norton & Co 1993.

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D. Denborough; Family Therapy: Exploring the Field's Past, Present and Possible Futures. Adelaide, South Australia: Dulwich Centre Publications, 2001.

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S.de Shazer: Clues; Investigating Solutions in Brief Therapy. W.W. Norton & Co 1988

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E.George, C.Iveson, H. Ratner; Problem to solution; brief therapy with individuals and families. BT Press, 1990.

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M.A. Hubble, B.L. Duncan, S.D. Miller; The Heart and Soul of Change; what works in therapy. American Psychological Association, 1999.

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S.D. Miller, M.A. Hubble, B.L. Duncan; Handbook of Solution-focused brief therapy. Jossey-Bass Publishers, 1996.

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B.O’Connell; Solution Focused Therapy. Sage, 1998.

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B.O’Hanlon and S. Beadle; A Field Guide to PossibilityLand: possibility therapy methods. BT Press 1996.

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B. O'Hanlon and M. Weiner-Davis: "In Search of Solutions: A New Direction in Psychotherapy." WW Norton & CO. New York 1989

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J.T. Guterman; Mastering the Art of Solution-Focused Counselling. American Counselling Association 2006.

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M.Talmon; Single Session Therapy; maximizing the effect of the first (and often only) therapeutic encounter. Jossey-Bass

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Publishers, 1990.

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Peter De Jong, Insoo Kim Berg Interviewing for Solutions Brooks Cole Publishers, 2nd edition 2002

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P.Ziegler and T. Hiller: Recreating Partnership: A Solution-Oriented, Collaborative Approach to Couples Therapy. W.W.

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Norton 2001.

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Guterman, J.T. (2006). Mastering the Art of Solution-Focused Counselling. Alexandria, VA: American Counselling

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Association. ISBN 1-55620-267-9

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Guterman, J.T., Mecias, A., Ainbinder, D.L. (2005). Solution-focused treatment of migraine headache. The Family

Brief (psycho-) therapy From Wikipedia, the free encyclopedia Brief psychotherapy or Brief therapy is an umbrella term for a variety of approaches to psychotherapy. It differs from other schools of therapy in that it emphasises (1) a focus on a specific problem and (2) direct intervention. In brief therapy, the therapist takes responsibility for working more pro-actively with the client in order to treat clinical and subjective conditions faster. It also emphasizes precise observation, utilization of natural resources, and temporary suspension of disbelief to consider new perspectives and multiple viewpoints. Rather than the formal analysis of historical causes of distress, the primary approach of brief therapy is to help the client to view the present from a wider context and to utilize more functional understandings (not necessarily at a conscious level). By becoming aware of these new understandings, successful clients will de facto undergo spontaneous and generative change. Brief therapy is often highly strategic, exploratory, and solution-based rather than problem-oriented. It is less concerned with how a problem arose than with the current factors sustaining it and preventing change. Brief therapists do not adhere to one "correct" approach, but rather accept that there being many paths, any of which may or may not in combination turn out to be ultimately beneficial.

Founding proponents of brief therapy Milton Erickson was a master of brief therapy, using clinical hypnosis as his primary tool. To a great extent he developed this himself. His approach was popularized by Jay Haley, in the book "Uncommon therapy: The psychiatric techniques of Milton Erickson M.D." "The analogy Erickson uses is that of a person who wants to change the course of a river. if he opposes the river by trying to block it, the river will merely go over and around him. But if he accepts the force of the river and diverts it in a new direction, the force of the river will cut a new channel." (Haley, "Uncommon therapy", p.24, emphasis in original) Richard Bandler, the co-founder of neuro-linguistic programming, is another firm proponent of brief therapy. After many years of studying Erickson's therapeutic work, he wrote: "It's easier to cure a phobia in ten minutes than in five years... I didn't realize that the speed with which you do things makes them last... I taught people the phobia cure. They'd do part of it one week, part of it the next, and part of it the week after. Then they'd come to me and say "It doesn't work!" If, however, you do it in five minutes, and repeat it till it happens very fast, the brain understands. That's part of how the brain learns... I discovered that the human mind does not learn slowly. It learns quickly. I didn't know that." (Time for a change, 1993, p.20)

Short-term counselling with lasting results

An Overview of Brief Therapy Brief Therapy is a model of therapy that focuses strongly on your present and future, as opposed to your past. Traditional psychotherapy tends to focus on the past and looks for the cause of problems. In contrast, Brief Therapy focuses on the solution to problems, which is why it is often called solution-oriented therapy. Some Brief Therapy experts would go so far as to say they don't even need to know what the past problems were to help the client. Although this is an extreme view, it does illustrate that Brief Therapy is firmly rooted in the present with an eye toward changing the future. The brief therapy solution-focused approach can be summed up in three stages, according to Peller and Walter (1992): 1. Find out what you (the client) want 2. Determine what is currently working for you and do more of that 3. Do something different. The simplicity of these stages belies their effectiveness. Consider, for example, the seemingly simple task of finding out what you want to achieve in therapy. Most people go into therapy knowing all too well what they don't want, what has been troubling them, or how frustrated they are by their problems. In the solution-focused model, our goal is to help you find out what you do want. Identifying your goal (or goals) is perhaps the single most important thing you will do in your Brief Therapy sessions. In effect, the goals that you articulate will guide you through the rest of your sessions, and they will be the mark against which you will measure your success. In the next stage, the emphasis is on finding out what parts of your life are working just fine. Brief Therapists are strong adherents to the "if it ain't broke don't fix it" philosophy. When we find out what parts of your life you're happy with, we can use them as a strong foundation upon which you can build an improved lifestyle. In traditional therapy, by contrast, the focus is on diagnosing what is wrong with you or what is not working for you. In Brief Therapy you will present your problems, but you will solve them by using the strengths that you already have. The last stage (Do something different) will help you when if you realize that one approach is not working effectively. Because everyone has an almost infinite capacity for creative solutions (even if you don't realize it now) we won't waste time on any approach that's not working for you. Since our time frame is measured in weeks and months (as opposed to years) we want to find a solution that works in the shortest time possible. Brief Therapy emphasizes the client as the expert. You will be in charge of your own therapy and you will decide when you have attained your goals. Your therapist will listen to what you have to say, and together you will develop goals and work collaboratively to find solutions. Perhaps the most important thing to remember is that Brief Therapy is effective because people are capable of change in a short amount of time.

Bowen’s Strategic Family Therapy - I Contents • • • • • • • • • • • • • •

Introduction

Family Systems Theory Introduction The pioneers of family therapy recognized that current social and cultural forces shape our values about ourselves and our families, our thoughts about what is "normal" and "healthy," and our expectations about how the world works. However, Bowen was the first to realize that the history of our family creates a template which shapes the values, thoughts, and experiences of each generation, as well as how that generation passes down these things to the next generation. Bowen was a medical doctor and the oldest child in a large cohesive family from Tennessee. He studied schizophrenia, thinking the cause for it began in mother-child symbiosis, which created an anxious and unhealthy attachment. He moved from studying dyads (two way relationships like parent-child and parent-parent) to triads (three way relationships like parent-parent-child and grandparent-parent-child) afterward. At a conference organized by Framo, one of his students, he explained his theory of how families develop and function, and presented as a case study his own family. Bowen's theory focuses on the balance of two forces. The first is togetherness and the second is individuality. Too much togetherness creates fusion and prevents individuality, or developing one's own sense of self. Too much individuality results in a distant and estranged family. Bowen introduced eight interlocking concepts to explain family development and functioning, each of which is described below. The family systems theory is a theory introduced by Dr. Murray Bowen that suggests that individuals cannot be understood in isolation from one another, but rather as a part of their family, as the family is an emotional unit. Families are systems of interconnected and interdependent individuals, none of whom can be understood in isolation from the system.

The family system According to Bowen, a family is a system in which each member has a role to play and rules to respect. Members of the system are expected to respond to each other in a certain way according to their role, which is determined by relationship agreements. Within the boundaries of the system, patterns develop as certain family member's behaviour is caused by and causes other family member's behaviours in predictable ways. Maintaining the same pattern of behaviours within a system may lead to balance in the family system, but also to dysfunction. For example, if a husband is depressive and cannot pull himself together, the wife may need to take up more responsibilities to pick up the slack. The change in roles may maintain the stability in the relationship, but it may also push the family towards a different equilibrium. This new equilibrium may lead to dysfunction as the wife may not be able to maintain this overachieving role over a long period of time. There are eight interlocking concepts in Dr. Bowen's theory: 1) Differentiation of self: The variance in individuals in their susceptibility to depend on others for acceptance and

approval. 2) Triangles: The smallest stable relationship system. Triangles usually have one side in conflict and two sides in

harmony, contributing to the development of clinical problems. 3) Nuclear family emotional system: The four relationship patterns that define where problems may develop in a

family. - Marital conflict - Dysfunction in one spouse - Impairment of one or more children - Emotional distance 4) Family projection process: The transmission of emotional problems from a parent to a child. 5) Multigenerational transmission process: The transmission of small differences in the levels of differentiation

between parents and their children. 6) Emotional cut-off: The act of reducing or cutting off emotional contact with family as a way of managing

unresolved emotional issues. 7) Sibling position: The impact of sibling position on development and behaviour. 8) Societal emotional process: The emotional system governs behaviour on a societal level, promoting both

progressive and regressive periods in a society.

1. Differentiation of Self The first concept is Differentiation of Self, or the ability to separate feelings and thoughts. Undifferentiated people can not separate feelings and thoughts; when asked to think, they are flooded with feelings, and have difficulty thinking logically and basing their responses on that. Further, they have difficulty separating their own from other's feelings; they look to family to define how they think about issues, feel about people, and interpret their experiences. Differentiation is the process of freeing yourself from your family's processes to define yourself. This means being able to have different opinions and values than your family members, but being able to stay emotionally connected to them. It means being able to calmly reflect on a conflicted interaction afterward, realizing your own role in it, and then choosing a different response for the future.

Differentiation of Self Families and other social groups tremendously affect how people think, feel, and act, but individuals vary in their susceptibility to a "group think" and groups vary in the amount of pressure they exert for conformity. These differences between individuals and between groups reflect differences in people's levels of differentiation of self. The less developed a person's "self," the more impact others have on his functioning and the more he tries to control, actively or passively, the functioning of others. The basic building blocks of a "self" are inborn, but an individual's family relationships during childhood and adolescence primarily determine how much "self" he develops. Once established, the level of "self" rarely changes unless a person makes a structured and long-term effort to change it. People with a poorly differentiated "self" depend so heavily on the acceptance and approval of others that either they quickly adjust what they think, say, and do to please others or they dogmatically proclaim what others should be like and pressure them to conform. Bullies depend on approval and acceptance as much as chameleons, but bullies push others to agree with them rather than their agreeing with others. Disagreement threatens a bully as much as it threatens a chameleon. An extreme rebel is a poorly differentiated person too, but he pretends to be a "self" by routinely opposing the positions of others. A person with a well-differentiated "self" recognizes his realistic dependence on others, but he can stay calm and clear headed enough in the face of conflict, criticism, and rejection to distinguish thinking rooted in a careful assessment of the facts from thinking clouded by emotionality. Thoughtfully acquired principles help guide decision-making about important family and social issues, making him less at the mercy of the feelings of the moment. What he decides and what he says matches what he does. He can act selflessly, but his acting in the best interests of the group is a thoughtful choice, not a response to relationship pressures. Confident in his thinking, he can either support another's view without being a disciple or reject another view without polarizing the differences. He defines himself without being pushy and deals with pressure to yield without being wishy-washy. Every human society has its well-differentiated people, poorly differentiated people, and people at many gradations between these extremes. Consequently, the families and other groups that make up a society differ in the intensity of their emotional interdependence depending on the differentiation levels of their members. The more intense the interdependence, the less the group's capacity to adapt to potentially stressful events without a marked escalation of chronic anxiety. Everyone is subject to problems in his work and personal life, but less differentiated people and families are vulnerable to periods of heightened chronic anxiety which contributes to their having a disproportionate share of society's most serious problems.

Example: The example of the Michael, Martha, Amy triangle reflects how a lack of differentiation of self plays out in a family unit; in their case, a moderately differentiated unit. (Triangles example ) The description that follows is of how this triangle would play out if Michael, Martha, and Amy were more differentiated people. Michael and Martha were quite happy during the first two years of their marriage. He liked making the major decisions, but did not assume he knew "best." He always told Martha what he was thinking and he listened carefully to her ideas. Their exchanges were usually thoughtful and led to decisions that respected the vital interests of both people. Martha had always been attracted to Michael's sense of responsibility and willingness to make decisions, but she also lived by a principle that she was responsible for thinking things through for herself and telling Michael what she thought. She did not assume Michael usually knew "best." [Analysis: Because the level of stress on a marriage is often less during the early years, particularly before the births of children and the addition of other responsibilities, the less adaptive moderately differentiated marriage and the more adaptive well-differentiated marriage can look similar because the tension level is low. Stress is necessary to expose the limits of a family's adaptive capacity.] Martha conceived during the third year of the marriage and had a fairly smooth pregnancy. She had a few physical problems, but dealt with them with equanimity. She was somewhat anxious about being an adequate mother but felt she could manage these fears. When she talked to Michael about her fears, she did not expect that he would solve them for her, but she thought more clearly about her fears when she talked them out with him. He listened but was not patronizing. He recognized his own fears about the coming changes in their lives and acknowledged them to Martha. [Analysis: The stresses associated with the real and anticipated changes of the pregnancy trigger some anxiety in both Michael and Martha, but their interaction does not escalate the anxiety and make it chronic. Martha had somewhat heightened needs and expectations of Michael, but she takes responsibility for managing her anxiety and has realistic expectations about what he can do for her. Michael does not get particularly reactive to Martha's expectations and recognizes he is anxious too. Each remains a resource to the other.] A female infant was born after a fairly smooth labor. They named her Amy. Martha weathered the delivery fairly well and was ready to go home when her doctor discharged her. The infant care over the next few months was physically exhausting for Martha, but she was not heavily burdened by anxieties about the baby or about her adequacy as a mother. She continued to talk to Michael about her thoughts and feelings and still did not feel he was supposed to do something to make her feel better. Although Michael had increasing work pressures he remained emotionally available to her, even if only by phone at times. He worried about work issues, but did not ruminate about them to Martha. When she asked how it was going, he responded fairly factually and appreciated her interest. He occasionally wished Martha would not get anxious about things, but realized she could manage. He was not compelled to "fix" things for her. [Analysis: Sure of herself as a person, Martha is able to relate to Amy without feeling overwhelmed by responsibilities and demands and without unfounded fears about the child's well-being. Sure of himself, Michael can meet the reality demands of his job without feeling guilty that he is neglecting Martha. Each spouse recognizes the pressure the other is under and neither makes a "federal case" about being neglected. Each is sufficiently confident in the other's loyalty and commitment that neither needs much reassurance about it. By the parents relating comfortably to each other, Amy is not triangled into marital tensions. She does not have a void to fill in her mother's life related to distance between her parents.]

After a few months, Michael and Martha were able to find time to do some things by themselves. Martha found that her anxieties about being a mother toned down and she did not worry much about Amy. As Amy grew, Martha did not perceive her as an insecure child that needed special attention. She was positive about Amy, but not constantly praising her in the name of reinforcing Amy's self-image. Michael and Martha discussed their thoughts and feelings about Amy, but they were not preoccupied with her. They were pleased to have her and took pleasure in watching her develop. Amy grew to be a responsible young child. She sensed the limits of what was realistic for her parents to do for her and respected those limits. There were few demands and no tantrums. Michael did not feel critical of Amy very often and Martha did not defend Amy to him when he was critical. Martha figured Michael and Amy could manage their relationship. Amy seemed equally comfortable with both of her parents and relished exploring her environment. [Analysis: Michael and Martha can see Amy as a separate and distinct person. The beginning differentiation between Amy and her parents is evident when Amy is a young child. They have adapted quite successfully to the anxieties they each experienced associated with the addition of a child and the increased demands in Michael's work life. Their high levels of differentiation allow the three of them to be in close contact with little triangling.]

2. Triangles Triangles are the basic units of systems. Dyads are inherently unstable, as two people will vacillate between closeness and distance. When distressed or feeling intense emotions, they will seek a third person to triangulate. â&#x20AC;˘

Think about a couple who has an argument, and afterward, one of the partners calls their parent or best friend to talk about the fight. The third person helps them reduce their anxiety and take action, or calm their strong emotions and reflect, or bolster their beliefs and make a decision.

People who are more undifferentiated are likely to triangulate others and be triangulated. People who are differentiated cope well with life and relationship stress, and thus are less likely to triangulate others or be triangulated. â&#x20AC;˘

Think of the person who can listen to the best friend's relationship problems without telling the friend what to do or only validating the friend's view. Instead, the differentiated person can tell the best friend "You know, you can be intimidating at those times..." or "I agree with you but you won't change your partner; you either have to learn to accept this about them, or have to call this relationship quits..."

Triangles A triangle is a three-person relationship system. It is considered the building block or "molecule" of larger emotional systems because a triangle is the smallest stable relationship system. A two-person system (dyad) is unstable because it tolerates little tension before involving a third person. A triangle can contain much more tension without involving another person because the tension can shift around three relationships. If the tension is too high for one triangle to contain, it spreads to a series of "interlocking" triangles. Spreading the tension can stabilize a system, but nothing gets resolved. People's actions in a triangle reflect their efforts to ensure their emotional attachments to important others, their reactions to too much intensity in the attachments, and their taking sides in the conflicts of others. Paradoxically, a triangle is more stable than a dyad, but a triangle creates an "odd man out," which is a very difficult position for individuals to tolerate. Anxiety generated by anticipating or being the odd one out is a potent force in triangles. The patterns in a triangle change with increasing tension. In calm periods, two people are comfortably close "insiders" and the third person is an uncomfortable "outsider." The insiders actively exclude the outsider and the outsider works to get closer to one of them. Someone is always uncomfortable in a triangle and pushing for change. The insiders solidify their bond by choosing each other in preference to the less desirable outsider. Someone choosing another person over oneself arouses particularly intense feelings of rejection. If mild to moderate tension develops between the insiders, the most uncomfortable one will move closer to the outsider. One of the original insiders now becomes the new outsider and the original outsider is now an insider. The new outsider will make predictable moves to restore closeness with one of the insiders. At moderate levels of tension, triangles usually have one side in conflict and two sides in harmony. The conflict is not inherent in the relationship in which it exists but reflects the overall functioning of the triangle. At a high level of tension, the outside position becomes the most desirable. If severe conflict erupts between the insiders, one insider opts for the outside position by getting the current outsider fighting with the other insider. If the maneuvering insider is successful, he gains the more comfortable position of watching the other two people fight. When the tension and conflict subside, the outsider will try to regain an inside position. Triangles contribute significantly to the development of clinical problems. Getting pushed from an inside to an outside position can trigger a depression or perhaps even a physical illness. Two parents intensely focusing on what is wrong with a child can trigger serious rebellion in the child.

Example: Michael and Martha were extremely happy during the first two years of their marriage. Michael liked making major decisions and Martha felt comforted by Michael's "strength." After some difficulty getting pregnant, Martha conceived during the third year of the marriage, but it was a difficult pregnancy. She was quite nauseous during the first trimester and developed blood pressure and weight gain problems as the pregnancy progressed. She talked frequently to Michael of her insecurities about being a mother. Michael was patient and reassuring, but also began to feel critical of Martha for being "childlike." [Analysis: The pregnancy places more pressure on Martha and on the marital relationship. Michael is outwardly supportive of Martha but is reactive to hearing about her anxieties. He views her as having a problem.] A female infant was born after a long labor. They named her Amy. Martha was exhausted and not ready to leave the hospital when her doctor discharged her. Over the next few months, she felt increasingly overwhelmed and extremely anxious about the well-being of the young baby. She looked to Michael for support, but he was getting home from the office later and Martha felt that he was critical of her problems coping and that he dismissed her worries about the child. There was much less time together for just Michael and Martha and, when there was time, Michael ruminated about work problems. Martha became increasingly preoccupied with making sure her growing child did not develop the insecurities she had. She tried to do this by being as attentive as she could to Amy and consistently reinforcing her accomplishments. It was easier for Martha to focus on Amy than it was for her to talk to Michael. She reacted intensely to his real and imagined criticisms of her. Michael and Martha spent more and more of their time together discussing Amy rather than talking about their marriage. [Analysis: Martha is the most uncomfortable with the increased tension in the marriage. The growing emotional distance in the marriage is balanced by Martha getting overly involved with Amy and Michael getting overly involved with his work. Michael is in the outside position in the parental triangle and Martha and Amy are in the inside positions.] As Amy grew, she made increasing demands on her mother's time. Martha felt she could not give Amy enough time, that Amy would never be satisfied. Michael agreed with Martha that Amy was too selfish and resented Amy's temper tantrums when she did not get her way. However, if Michael got too critical of Amy, Martha would defend Amy, telling Michael he was exaggerating. Yet, whenever tensions developed between Martha and Amy, Martha would press Michael to spend more time with Amy to reassure her that she was loved. He gave into Martha's pleas, but inwardly felt that they were following a policy of appeasement that was making Amy more demanding. Michael felt that if Martha had his maturity, Amy would be less of a problem, but, despite this attitude, Michael usually followed Martha's lead in relationship to Amy. [Analysis: When tension builds between Martha and Amy, Michael sides with Martha by agreeing that Amy is the problem. The conflictual side of the triangle then shifts from between Martha and Amy to between Michael and Amy. If the conflict gets too intense between Michael and Amy, Martha sides with Amy, the conflict shifts into the marriage, and Amy gains the more comfortable outside position.]

3. The Nuclear Family Emotional Processes These are the emotional patterns in a family that continue over the generations. â&#x20AC;˘

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Think about a mother who lived through The Great Depression, and taught her daughter to always prepare for the worst case scenario and be happy simply if things are not that bad. The daughter thinks her mother is wise, and so adopts this way of thinking. She grows up, has a son, and without realizing it, models this way of thinking. He may follow or reject it, and whether he has a happy or distressed relationship may depend on the kind of partner he finds. Likewise, think of a daughter who goes to work for her father, who built his own father's small struggling business into a thriving company. He is seen in the family as a great businessperson as he did this by taking risks in a time of great economic opportunity. He teaches his daughter to take risks, "spend money to make money," and assume a great idea will always be profitable. His daughter may follow or reject her father's advice, and her success will depend on whether she faces an economic boom or recession.

In both cases, the parent passes on an emotional view of the world (the emotional process), which is taught each generation from parent to child, the smallest possible "unit" of family (the nuclear unit). Reactions to this process can range from open conflict, to physical or emotional problems in one family member, to reactive distancing (see below). Problems with family members may include things like substance abuse, irresponsibility, depression....

Nuclear Family Emotional System The concept of the nuclear family emotional system describes four basic relationship patterns that govern where problems develop in a family. People's attitudes and beliefs about relationships play a role in the patterns, but the forces primarily driving them are part of the emotional system. The patterns operate in intact, single-parent, stepparent, and other nuclear family configurations. Clinical problems or symptoms usually develop during periods of heightened and prolonged family tension. The level of tension depends on the stress a family encounters, how a family adapts to the stress, and on a family's connection with extended family and social networks. Tension increases the activity of one or more of the four relationship patterns. Where symptoms develop depends on which patterns are most active. The higher the tension, the more chance that symptoms will be severe and that several people will be symptomatic. The four basic relationship patterns are: Marital conflict- As family tension increases and the spouses get more anxious, each spouse externalizes his or her anxiety into the marital relationship. Each focuses on what is wrong with the other, each tries to control the other, and each resists the other's efforts at control. Dysfunction in one spouse- One spouse pressures the other to think and act in certain ways and the other yields to the pressure. Both spouses accommodate to preserve harmony, but one does more of it. The interaction is comfortable for both people up to a point, but if family tension rises further, the subordinate spouse may yield so much self-control that his or her anxiety increases significantly. The anxiety fuels, if other necessary factors are present, the development of a psychiatric, medical, or social dysfunction. Impairment of one or more children- The spouses focus their anxieties on one or more of their children. They worry excessively and usually have an idealized or negative view of the child. The more the parents focus on the child the more the child focuses on them. He is more reactive than his siblings to the attitudes, needs, and expectations of the parents. The process undercuts the child's differentiation from the family and

makes him vulnerable to act out or internalize family tensions. The child's anxiety can impair his school performance, social relationships, and even his health. Emotional distance- This pattern is consistently associated with the others. People distance from each other to reduce the intensity of the relationship, but risk becoming too isolated. The basic relationship patterns result in family tensions coming to rest in certain parts of the family. The more anxiety one person or one relationship absorbs, the less other people must absorb. This means that some family members maintain their functioning at the expense of others. People do not want to hurt each other, but when anxiety chronically dictates behaviour, someone usually suffers for it. Example: The tensions generated by Michael and Martha's interactions lead to emotional distance between them and to an anxious focus on Amy. Amy reacts to her parents' emotional over involvement with her by making immature demands on them, particularly on her mother. [Analysis: A parent's emotional over involvement with a child programs the child to be as emotionally focused on the parent as the parent is on the child and to react intensely to real or imagined signs of withdrawal by the parent.] When Amy was four years old, Martha got pregnant again. She wanted another child, but soon began to worry about whether she could meet the emotional needs of two children. Would Amy be harmed by feeling left out? Martha worried about telling Amy that she would soon have a little brother or sister, wanting to put off dealing with her anticipated reaction as long as possible. Michael thought it was silly but went along with Martha. He was outwardly supportive about the pregnancy, he too wanted another child, but he worried about Martha's ability to cope. [Analysis: Martha externalizes her anxiety onto Amy rather than onto her husband or rather than internalizing it. Michael avoids conflict with Martha by supporting the focus on Amy and avoids dealing with his own anxieties by focusing on Martha's coping abilities.] Apart from her fairly intense anxieties about Amy, Martha's second pregnancy was easier than the first. A daughter, Marie, was born without complications. This time Michael took more time away from work to help at home, feeling and seeing that Martha seemed "on the edge." He took over many household duties and was even more directive of Martha. Martha was obsessed with Amy feeling displaced by Marie and gave in even more to Amy's demands for attention. Martha and Amy began to get into struggles over how available Martha could be to her. When Michael would get home at night, he would take Amy off her mother's hands and entertain her. He also began feeling neglected himself and quite disappointed in Martha's lack of coping ability.. Martha had done some drinking before she married Michael and after Amy was born, but stopped completely during the pregnancy with Marie. When Marie was a few months old, however, Martha began drinking again, mostly wine during the evenings, and much more than in the past. She somewhat tried to cover up the amount of drinking she did, feeling Michael would be critical of it. He was. He accused her of not trying, not caring, and being selfish. Martha felt he was right. She felt less and less able to make decisions and more and more dependent on Michael. She felt he deserved better, but also resented his criticism and patronizing. She drank more, even during the day. Michael began calling her an alcoholic. [Analysis: The pattern of sickness in a spouse has emerged, with Martha as the one making the most adjustments in her functioning to preserve harmony in the marriage. It is easier for Martha to be the problem than to stand up to Michael's diagnosing her and, besides, she feels she really is the problem.

As the pattern unfolds, Michael increasingly over functions and Martha increasingly under functions. Michael is as allergic to conflict as Martha is, opting to function for her rather than risk the disharmony he would trigger by expecting her to function more responsibly.] By the time Amy and Marie were both in school, Martha reached a serious low point. She felt worthless and out of control. She felt Michael did everything, but that she could not talk to him. Her doctor was concerned about her physical health. Finally, Martha confided in him about the extent of her drinking. Michael had been pushing her to get help, but Martha had reached a point of resisting almost all of Michael's directives. However, her doctor scared her and she decided to go to Alcoholics Anonymous. Martha felt completely accepted by the A.A. group and greatly relieved to tell her story. She stopped drinking almost immediately and developed a very close connection to her sponsor, an older woman. She felt she could be herself with the people at A.A. in a way she could not be with Michael. She began to function much better at home, began a part-time job, but also attended A.A. meetings frequently. Michael had complained bitterly about her drinking, but now he complained about her preoccupation with her new found A.A. friends. Martha gained a certain strength from her new friends and was encouraged by them "to stand up" to Michael. She did. They began fighting frequently. Martha felt more like herself again. Michael was bitter. [Analysis: Martha's involvement with A.A. helped her stop drinking, but it did not solve the family problem. The level of family tension has not changed and the emotional distance in the marriage has not changed. Because of "borrowing strength" from her A.A. group, Martha is more inclined to fight with Michael than to go along and internalize the anxiety. This means the marital pattern has shifted somewhat from dysfunction in a spouse to marital conflict, but the family has not changed in a basic way. In other words, Martha's level of differentiation of self has not changed through her A.A. involvement, but her functioning has improved.]

4. The Family Projection Process This is an extension of The Nuclear Family Emotional Process in many ways. The family member who "has" the "problem" is triangulated and serves to stabilize a dyad in the family. â&#x20AC;˘

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Thus, the son who rejects his mother's pessimistic view may find his mother and sister become closer, as they agree that he is immature and irresponsible. The more they share this view with him, the more it makes him feel excluded and shapes how he sees himself. He may act in accord with this view and behave more and more irresponsibly. He may reject it, constantly trying to "prove" himself to be mature and responsible, but failing to gain his family's approval because they do not attribute his successes to his own abilities ("He was so lucky that his company had a job opening when he applied..." or "It's a good thing the loan officer felt sorry for him because he couldn't have managed it without that loan..."). He might turn to substance abuse as he becomes more and more irresponsible, or as he struggles with never meeting his family's expectations. Similarly, the daughter who faces harsh economic times and is more fiscally conservative than her father is seen by the parents as too rigid and dull. They join together to worry that she'll never be happily married. She might accept this role and become a workaholic who has only superficial relationships, or reject it and take wild risks that fail. In the end, she may become depressed as she works more and more, or as she fails to live up to her father's reputation as a creative and successful business person.

The family member who serves as the "screen" upon which the family "projects" this story will have great trouble differentiating. It will be hard for the son or daughter above to hold their own opinions and values, maintain their emotional strength, and make their own choices freely despite the family's view of them.

Family Projection Process The family projection process describes the primary way parents transmit their emotional problems to a child. The projection process can impair the functioning of one or more children and increase their vulnerability to clinical symptoms. Children inherit many types of problems (as well as strengths) through the relationships with their parents, but the problems they inherit that most affect their lives are relationship sensitivities such as heightened needs for attention and approval, difficulty dealing with expectations, the tendency to blame oneself or others, feeling responsible for the happiness of others or that others are responsible for one's own happiness, and acting impulsively to relieve the anxiety of the moment rather than tolerating anxiety and acting thoughtfully. If the projection process is fairly intense, the child develops stronger relationship sensitivities than his parents. The sensitivities increase a person's vulnerability to symptoms by fostering behaviours that escalate chronic anxiety in a relationship system. The projection process follows three steps: (1) the parent focuses on a child out of fear that something is wrong with the child; (2) the parent interprets the child's behaviour as confirming the fear; and (3) the parent treats the child as if something is really wrong with the child. These steps of scanning, diagnosing, and treating begin early in the child's life and continue. The parents' fears and perceptions so shape the child's development and behaviour that he grows to embody their fears and perceptions. One reason the projection process is a self-fulfilling prophecy is that parents try to "fix" the problem they have diagnosed in the child; for example, parents perceive their child to have low self-esteem, they repeatedly try to affirm the child, and the child's self-esteem grows dependent on their affirmation.

Parents often feel they have not given enough love, attention, or support to a child manifesting problems, but they have invested more time, energy, and worry in this child than in his siblings. The siblings less involved in the family projection process have a more mature and reality-based relationship with their parents that fosters the siblings developing into less needy, less reactive, and more goal-directed people. Both parents participate equally in the family projection process, but in different ways. The mother is usually the primary caretaker and more prone than the father to excessive emotional involvement with one or more of the children. The father typically occupies the outside position in the parental triangle, except during periods of heightened tension in the mother-child relationship. Both parents are unsure of themselves in relationship to the child, but commonly one parent acts sure of himself or herself and the other parent goes along. The intensity of the projection process is unrelated to the amount of time parents spend with a child. Example: The case of Michael, Martha, and Amy illustrates the family projection process. Martha's anxiety about Amy began before Amy was born. Martha feared she would transfer inadequacies she had felt as a child, and still felt, to her own child. This was one reason Martha had mixed feelings about being a mother. Like many parents, Martha felt a mother's most important task was to make a child feel loved. In the name of showing love, she was acutely responsive to Amy's desires for attention. If Amy seemed bored and out of sorts, Martha was there with an idea or plan. She believed a child's road to confidence and independence was in the child feeling secure about herself. Martha did not recognize how sensitive she was to any sign in Amy that she might be upset or troubled and how quickly she would move in to fix the problem. Martha loved Amy deeply. She and Amy often seemed like one person in the way they were attuned to each other. As a very small toddler, Amy was as sensitive to her mother's moods and wants as Martha was to Amy's moods and wants. [Analysis: Martha's excessive involvement programs Amy to want much of her mother's attention and to be highly sensitive to her mother's emotional state. Both mother and child act to reinforce the intense connection between them.] At some point in the unfolding of their relationship, Martha began to feel irritated at times by what Martha regarded as Amy's "insatiable need" for attention. Martha would try to distance from Amy's neediness, but not very successfully because Amy had ways to involve her mother with her. Martha flip-flopped between pleading with and cajoling Amy one minute and being angry at and directive of her the next. It seemed to lock them together even more tightly. Martha looked to Michael to take over at such times. Despite calling Amy's need for attention insatiable, Martha felt Amy really needed more of her time and she faulted herself for not being able to give enough. She wanted Michael to help with the task. It bothered Martha if Amy seemed upset with her. Amy's upsets triggered guilt in Martha and a fear that they were no longer close companions. She wanted to soothe Amy and feel close to her. [Analysis: Martha blames Amy for the demands she makes on her, but at the same time feels she is failing Amy. Martha tries to "fix" Amy's problem by doing more of what she has already been doing and solicits Michael's help in it. Martha is meeting many of her own needs for emotional closeness and companionship through Amy, thus gets very distressed if Amy seems unhappy with her. The marital distance accentuates Martha's need for Amy.] Martha's second pregnancy changed a reasonably manageable situation into an unmanageable one. The dilemma of meeting the needs of both children seemed impossible to Martha. She felt Amy was already showing signs of "inheriting" her insecurities. How had she failed her?

When it was time for Amy to start school, Martha sought long conferences with the kindergarten teacher to plan the transition. If Amy balked at going to school, Martha became frightened, angry, exasperated, and guilty. The kindergarten teacher felt she understood children like Amy and took great interest in her. Amy was bright, thrived on the teacher's attention, and performed very well in school. Martha had none of these fears when Marie started school and, not surprisingly, none of the school transition problems occurred with her. Marie did not seem to require so much of the teacher's attention; she just pursued her interests. As Amy progressed through grade school, her adjustment to school seemed to depend heavily on the teacher she had in a particular year. If the teacher seemed to take an unusual interest in her, she performed very well, but if the teacher treated her as one of the group, she would lose interest in her work. Martha focused on making sure Amy got the "right" teacher whenever possible. Marie's performance did not depend on a particular teacher. [Analysis: Martha's difficulty being a "self" with her children is reflected in her feeling inordinately responsible for the happiness of both children. This makes it extremely difficult for her to interact comfortably with two children. Amy transfers the relationship intensity she has with her mother to her teachers. When a teacher makes her special, Amy performs very well, but without that type of relationship, Amy performs less well. Marie is less involved with her mother and, consequently, her performance is less dependent on the relationship environment at school and at home.] If Amy complained about the ways other kids treated her in school, Martha and Michael would talk to her about not being so sensitive, telling her she should not care so much about what other people think. If Amy had a special friend, she was extremely sensitive to that friend paying attention to another little girl. Martha lectured Amy about being less sensitive but also planned outings and parties designed to help Amy with her friendships. Michael criticized Martha for this, saying Amy should work out these problems for herself, but he basically went along with all of Martha's efforts. [Analysis: The parents' words do not match their actions. They lecture Amy about being less sensitive, but the frequent lectures belie their own anxieties about such issues and their doubts about Amy's ability to cope. Amy's sensitivity to being in the outside position in a triangle with her playmates reflects her programming for such relationship sensitivities in the parental triangle.] Martha and Amy had turmoil in their relationship during Amy's elementary school years, but things got worse in middle school. Amy began having academic problems and complained about feeling lost in the larger school. She seemed unhappy to Martha. Martha talked to Michael and to the pediatrician about getting therapy for Amy. They hired tutors for Amy in two of her subjects, even though they knew that part of the problem was Amy not working hard in those subjects. When Amy's grades did not improve, Michael criticized her for not taking advantage of the help they were giving and not appreciating them as parents. Martha scolded Michael for being too hard on Amy, but inwardly she felt even more critical of her than Michael did. She had worked hard to prevent these very problems in Amy. How could Amy disappoint her so much? In the summers when there were no academic pressures, Martha and Amy got along much better. [Analysis: Commonly parents get critical of a child with whom they have been excessively involved if the child's performance drops. They push for the child to have therapy or tutors rather than think about the changes they themselves need to make. Medicine, psychiatry, and the larger society usually reinforce the child focus by defining the problem as being in the child and by often implying that the parents are not attentive and caring enough.]

The big changes occurred when Amy started high school. Martha felt Amy was telling her less of what was happening in her life and that she was more sullen and withdrawn. Amy also had a new group of girlfriends that seemed less desirable to Martha. Amy had also found boys. Martha and Amy got into more frequent conflicts. Amy felt controlled by her parents, not given the freedom to make her own decisions, pick her own friends. She resented her mother's obvious intrusions into her room when she was out. She began lying to her mother in an effort to evade her rules. Martha was no longer drinking herself at this point, but worried that Amy was using drugs and alcohol. She challenged Amy about it, but her challenges were met with denials. When Martha felt particularly overwhelmed by the situation, Michael would step in and try to lay down the law to Amy. He accused Amy of not appreciating all they had done for her and of deliberately trying to hurt them. He wanted to know "why" she disobeyed them. Amy would lash back at her father in these discussions, at which point Martha would intervene. Amy stayed away from the house more, told her parents less and less, and got in with a fairly wild crowd. She acted out some of her parents worst fears, but did not feel particularly good about herself and about what she was doing. Amy felt alienated from her parents. The parents' focus on her deteriorating grades included lectures and groundings, but Amy easily evaded these efforts to control and change her. [Analysis: The more intense the family projection process has been, the more intense the adolescent rebellion. Parents typically blame the rebellion on adolescence, but the parents reactivity to the child fuels the rebellion as much as the child's reactivity. When the parents demand to know "why" Amy acts as she does, they place the problem in Amy. Similarly, parents often blame the influence of the peer group, which also places the problem outside themselves. Peers are an important influence, but a child's vulnerability to peer pressure is related to the intensity of the family process. The intense family process closes down communication and isolates Amy from the family. This is why a child who is very intensely connected to her parents can feel distant from them. The siblings who are less involved in the family problem navigate adolescence more smoothly.] Michael and Martha became increasingly critical of Amy, but also latched onto any signs she might be doing a little better. They gave her her own phone, bought the clothes she "just had to have," and gave her a car for her sixteenth birthday. Many of these things were done in the name of making Amy feel special and important, hoping that would motivate her to do better. Throughout all the turmoil surrounding Amy, Marie presented few problems. [Analysis: The parents' permissiveness is just as important in perpetuating the problems in Amy as the critical focus on her. As a teenager, Amy is just as critical of her parents as they are of her. Marie is a more mature person than Amy, but she is not free of the family problem; for example, she sides with her parents in blaming Amy for the family turmoil.]

5. The Multigenerational Transmission Process This process entails the way family emotional processes are transferred and maintained over the generations. This captures how the whole family joins in The Family Projection Process, for example, by reinforcing the beliefs of the family. As the family continues this pattern over generations, the also refer back to previous generations ("He's just like his Uncle Albert - he was always irresponsible too" or "She's just like your cousin Jenny - she was divorced four times.").

Multigenerational Transmission Process The concept of the multigenerational transmission process describes how small differences in the levels of differentiation between parents and their offspring lead over many generations to marked differences in differentiation among the members of a multigenerational family. The information creating these differences is transmitted across generations through relationships. The transmission occurs on several interconnected levels ranging from the conscious teaching and learning of information to the automatic and unconscious programming of emotional reactions and behaviours. Relationally and genetically transmitted information interact to shape an individual's "self." The combination of parents actively shaping the development of their offspring, offspring innately responding to their parents' moods, attitudes, and actions, and the long dependency period of human offspring results in people developing levels of differentiation of self similar to their parents' levels. However, the relationship patterns of nuclear family emotional systems often result in at least one member of a sibling group developing a little more "self" and another member developing a little less "self" than the parents. The next step in the multigenerational transmission process is people predictably selecting mates with levels of differentiation of self that match their own. Therefore, if one sibling's level of "self" is higher and another sibling's level of "self" is lower than the parents, one sibling's marriage is more differentiated and the other sibling's marriage is less differentiated than the parents' marriage. If each sibling then has a child who is more differentiated and a child who is less differentiated than himself, one three generational line becomes progressively more differentiated (the most differentiated child of the most differentiated sibling) and one line becomes progressively less differentiated (the least differentiated child of the least differentiated sibling). As these processes repeat over multiple generations, the differences between family lines grow increasingly marked. Level of differentiation of self can affect longevity, marital stability, reproduction, health, educational accomplishments, and occupational success. This impact of differentiation on overall life functioning explains the marked variation that typically exists in the lives of the members of a multigenerational family. The highly differentiated people have unusually stable nuclear families and contribute much to society; the poorly differentiated people have chaotic personal lives and depend heavily on others to sustain them. A key implication of the multigenerational concept is that the roots of the most severe human problems as well as of the highest levels of human adaptation are generations deep. The multigenerational transmission process not only programs the levels of "self" people develop, but it also programs how people interact with others. Both types of programming affect the selection of a spouse. For example, if a family programs someone to attach intensely to others and to function in a helpless and indecisive way, he will likely select a mate who not only attaches to him with equal intensity, but one who directs others and make decisions for them.

Example: The multigenerational transmission process helps explain the particular patterns that have played out in the nuclear family of Michael, Martha, Amy, and Marie. Martha is the youngest of three daughters from an intact Midwestern family. From her teen years on, Martha did not feel especially close to either of her parents, but especially to her

mother. She experienced her mother as competent and caring but often intrusive and critical. Martha felt she could not please her mother. Her sisters seemed to feel more secure and competent than Martha. She asked herself how she could grow up in a seemingly "normal" family and have so many problems, and answered herself that there must be something wrong with her. When she faced important dilemmas in her life and had decisions to make, her mother got involved and strongly influenced Martha's choices. Her mother said Martha should make her own decisions, but her mother's actions did not match her words. One of her mother's biggest fears was that Martha would make the wrong decision. In time, Martha's sisters came to view her much like their mother did and treated her as the baby of the family, as one needing special guidance. Martha's father was sympathetic with her one-down position in the family, but he distanced from family tensions. Martha detested herself for needing the acceptance and approval of others to function effectively and for feeling she could not act more independently. She worried about making the wrong decision and turned frequently to her mother for help. [Analysis: The primary relationship pattern in Martha's family of origin was impairment of one or more children, and the projection process focused primarily on Martha. The mother's overfunctioning promoted Martha's underfunctioning, but Martha largely blamed herself for her difficulties making decisions and functioning independently. Martha's intense need for approval and acceptance reflected the high level of involvement with her mother. She managed the intensity with her mother with emotional distance. These basic patterns were later replicated in her marriage and with Amy.] Martha's mother is the oldest child in her family and functioned as a second parent to her three younger siblings. Martha's mother's mother became a chronic invalid after her last child was born. As a child, Martha's mother functioned as a second mother in her family and, with the encouragement of her father, did much of the caretaking of her invalid mother. Martha's mother basked in the approval she gained from both of her parents, especially from her father. Her father was often critical of his wife, insisting she could do more for herself if she would try. Martha's grandmother responded to the criticism by taking to bed, often for days at a time. Martha's mother learned to thrive on taking care of others and being needed. [Analysis: Martha's mother probably had almost as intense an involvement with her parents as she subsequently had with Martha, but the styles of the involvements were different. Two relationship patterns dominated Martha's mother's nuclear family: dysfunction in one spouse and overinvolvement with a child. Martha's mother was intensely involved in the triangles with her parents and younger siblings and in the position of overfunctioning for others. In other words, she learned to meet her strongly programmed needs for emotional closeness by taking care of others, a pattern that played out with Martha.] Michael grew up as an only child in an intact family from the Pacific Northwest. He met Martha when he attended college in the Midwest. Michael's mother began having frequent bouts of serious depression about the time he started grade school. She was twice hospitalized psychiatrically, once after an overdose of tranquilizers. Michael felt "allergic" to his mother's many problems and kept his distance from her, especially during his adolescence. He cared about her and felt she would help him in any way she could, but viewed her as helpless and incompetent. He resented her "not trying harder." He had a reasonably comfortable relationship with his father, but felt his father made the family situation worse by opting for "peace at any price." It was easier for his father to give in to his wife's sometimes childish demands than to draw a line with her.

Michael related to his mother almost exactly like his father did. His mother expressed resentment about her husband's passivity. She accused him of not really caring about her, only doing things for her because she demanded it. Michael's mother worshiped Michael and was jealous of interests and people that took him away from her.

[Analysis: Interestingly, Michael's parental triangle was similar to Martha's mother's parental triangle. His mother was intensely involved with him and it programmed Michael both to need this level of emotional support from the important female in his life, but also to react critically to the female's neediness. Michael's parental triangle also fostered a belief that he knew best.] Michael's mother had been a "star" in her family when she was growing up. She was an excellent student and athlete. She had a very conflictual relationship with her mother and an idealized view of her father. She met Michael's father when they were both in college. He was two years older than she and when he graduated, she quit school to marry him. Her parents were very upset about the decision. Michael's father had been at loose ends when he met his future wife, but she was what he needed. He built a very successful business career with her emotional support. He functioned higher in his work life than in his family life. [Analysis: Michael's father functioned on a higher level in his business life than in his family life, a discrepancy that is commonly present in people with mid-range levels of differentiation of self.]

6. Sibling Position Bowen stressed sibling order, believing that each child had a place in the family hierarchy, and thus was more or less likely to fit some projections. The oldest sibling was more likely to be seen as overly responsible and mature, and the youngest as overly irresponsible and immature for example. â&#x20AC;˘ â&#x20AC;˘

Think of the oldest sibling who grows up and partners with a person who was also an oldest sibling. They may be drawn to each other because both believe the other is mature and responsible. Alternately, an oldest sibling might have a relationship with someone who was a youngest sibling. When one partner behaves a certain way, the other might think "This is exactly how my older/younger sibling used to act."

Sibling Position Bowen theory incorporates the research of psychologist Walter Toman as a foundation for its concept of sibling position. Bowen observed the impact of sibling position on development and behaviour in his family research. However, he found Toman's work so thorough and consistent with his ideas that he incorporated it into his theory. The basic idea is that people who grow up in the same sibling position predictably have important common characteristics. For example, oldest children tend to gravitate to leadership positions and youngest children often prefer to be followers. The characteristics of one position are not "better" than those of another position, but are complementary. For example, a boss who is an oldest child may work unusually well with a first assistant who is a youngest child. Youngest children may like to be in charge, but their leadership style typically differs from an oldest's style. Toman's research showed that spouses' sibling positions affect the chance of their divorcing. For example, if an older brother of a younger sister marries a younger sister of an older brother, less chance of a divorce exists than if an older brother of a brother marries an older sister of a sister. The sibling or rank positions are complementary in the first case and each spouse is familiar with living with someone of the opposite sex. In the second case, however, the rank positions are not complementary and neither spouse grew up with a member of the opposite sex. An older brother of a brother and an older sister of a sister are prone to battle over who is in charge; two youngest children are prone to struggle over who gets to lean on whom. People in the same sibling position, of course, exhibit marked differences in functioning. The concept of differentiation can explain some of the differences. For example, rather than being comfortable with responsibility and leadership, an oldest child who is anxiously focused on may grow up to be markedly indecisive and highly reactive to expectations. Consequently, his younger brother may become a "functional oldest," filling a void in the family system. He is the chronologically younger child, but develops more characteristics of an oldest child than his older brother. A youngest child who is anxiously focused on may become an unusually helpless and demanding person. In contrast, two mature youngest children may cooperate extremely effectively in a marriage and be at very low risk for a divorce.

Middle children exhibit the functional characteristics of two sibling positions. For example, if a girl has an older brother and a younger sister, she usually has some of the characteristics of both a younger sister of a brother and an older sister of a sister. The sibling positions of a person's parents are also important to consider. An oldest child whose parents are both youngests encounters a different set of parental expectations than an oldest child whose parents are both oldests.

Example: Knowledge of Michael and Martha Michael is an only child who, like Martha's mother, was raised in a family with a mother who had many problems. Michael's father is the younger brother of a sister and his mother is the older sister of a brother. Michael's mother was the more focused on child when she was growing up, a focus that took the form of high performance expectations coupled with considerable family anxiety about her ability to meet those expectations. In many ways, Michael's Martha's sibling positions and those of their parents adds to the understanding of how things played out in their lives. Martha is the youngest of three girls and was the most intensely focused on child in her family. Furthermore, Martha's mother is the oldest of four siblings and was raised in a family with a mother who was a chronic invalid. Martha's mother was a not very well differentiated oldest daughter. Her life energy focused on taking care of and directing others to the point that she unwittingly undermined the functioning of her youngest daughter. Martha played out the opposite side of the problem by becoming an indecisive, helpless, and mostly selfblaming person. Martha's father was the youngest brother in a family of five children. [Analysis: Martha, by virtue of her mother's focus on her, has the moderately exaggerated traits of a youngest child. Furthermore, her father being a youngest and her mother an oldest favored her mother's functioning setting the tone in the family. In other words, her mother was quicker to act than her father in face of problems.] father was quite dependent on his wife for affirmation and direction, even when she was depressed and overwhelmed. As an only child, the pattern of functioning of the triangle with his parents was the major influence on Michael's development. His emotional programming in that triangle made him a perfect fit with Martha. [Analysis: Michael's only child position makes him a somewhat reluctant leader in his nuclear family. He wants Martha to function better and to take more responsibility. He is unhappy feeling the pressure himself. Despite being in the one-up position in the marriage, he is as dependent on Martha as his father was dependent on his wife.]

7. Emotional Cutoff This refers to an extreme response to The Family Projection Process. This entails a complete or almost-complete separation from the family. The person will have little, if any, contact, and may look and feel completely independent from the family. However, people who cut off their family are more likely to repeat the emotional and behavioural patterns they were taught. â&#x20AC;˘

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In some cases, they model the same values and coping patterns in their adult family that they were taught in their childhood family without realizing it. They do not have another internal model for how families live, and so it is very hard to "do something different." Thus, some parents from emotionally constrained families may resent how they were raised, but they do not know how to be "emotionally free" and raise a family as they believe other families would. In other cases, they consciously attempt to be very different as parents and partners; however, they fail to realize the adaptive characteristics of their family and role models, as well as the compensatory roles played in a complex family. Thus, some parents from emotionally constrained childhood families might discover ways to be "emotionally unrestrained" in their adult families, but may not recognize some of the problems associated with being so emotionally unrestrained, or the benefits of being emotionally constrained in some cases. Because of this, Bowen believed that people tend to seek out partners who are at about the same level of individuation.

Emotional Cutoff The concept of emotional cutoff describes people managing their unresolved emotional issues with parents, siblings, and other family members by reducing or totally cutting off emotional contact with them. Emotional contact can be reduced by people moving away from their families and rarely going home, or it can be reduced by people staying in physical contact with their families but avoiding sensitive issues. Relationships may look "better" if people cutoff to manage them, but the problems are dormant and not resolved. People reduce the tensions of family interactions by cutting off, but risk making their new relationships too important. For example, the more a man cuts off from his family of origin, the more he looks to his spouse, children, and friends to meet his needs. This makes him vulnerable to pressuring them to be certain ways for him or accommodating too much to their expectations of him out of fear of jeopardizing the relationship. New relationships are typically smooth in the beginning, but the patterns people are trying to escape eventually emerge and generate tensions. People who are cut off may try to stabilize their intimate relationships by creating substitute "families" with social and work relationships. Everyone has some degree of unresolved attachment to his or her original family, but well-differentiated people have much more resolution than less differentiated people. An unresolved attachment can take many forms. For example, (1) a person feels more like a child when he is home and looks to his parents to make decisions for him that he can make for himself, or (2) a person feels guilty when he is in more contact with his parents and that he must solve their conflicts or distresses, or (3) a person feels enraged that his parents do not seem to understand or approve of him. An unresolved attachment relates to the immaturity of both the parents and the adult child, but people typically blame themselves or others for the problems. People often look forward to going home, hoping things will be different this time, but the old interactions usually surface within hours. It may take the form of surface harmony with powerful emotional undercurrents or it may deteriorate into shouting matches and hysterics. Both the person and his family may feel exhausted even after a brief visit. It may be easier for the parents if an adult child keeps his distance. The family gets so anxious and reactive when he is home that they are relieved when he leaves. The siblings of a highly cutoff member often get furious at him when he is home and blame him for upsetting the parents. People do not want it to be this way, but the sensitivities of all parties preclude comfortable contact.

Example: Neither Michael nor Martha wanted to live near their families. When Michael got a good job offer on the East coast, both of them were eager to move east. They told their families they were moving away because of Michael's great job offer, but they welcomed the physical distance from their families. Michael felt guilty about living far away from his parents and his parents were upset about it, especially Michael's mother. Michael called home every weekend and managed to combine business trips with brief stays with his parents. He did not look forward to the phone calls and usually felt depressed after them. He felt as if his mother deliberately put him on "guilt trips" by emphasizing how poorly she was doing and how much she missed seeing him. She never failed to ask if his company could transfer him closer to home. It was much less depressing for Michael to talk to his father, but they talked mostly about Michael's job and what his Dad was doing in retirement. [Analysis: Michael blamed his mother for the problems in their relationship and, despite his guilt, felt justified distancing from her. People commonly have a "stickier" unresolved emotional attachment with their mothers than with their fathers because the way a parental triangle usually operates is that the mother is too involved with the child and the father is in the outside position.] In the early years, Martha would sometimes participate in Michael's phone calls home but, as her problems mounted, she usually left the calls to Michael. Michael did not say much to his parents about Martha's drinking or about the tensions in their marriage. He would report on how the kids were doing. Michael, Martha, and the kids usually made one visit to Michael's parents each year. They did not look forward to the four days they would spend there, but Michael's mother thrived on having them. Martha never said anything to Michael's parents about her drinking or the marital tensions, but she talked at length about Amy to Michael's mother. Amy often developed middle ear infections during or soon after these trips. [Analysis: Frequently one or more family members get sick leading up to, during, or soon after trips home. Amy was more vulnerable because of the anxious focus on her.] Martha followed a pattern similar to Michael's in dealing with her family. One difference was that her parents came east fairly often. When they came, Martha's mother would get more worried about Martha and critical of both her drinking and of how she was raising Amy. Martha dreaded these exchanges with her mother and complained to Michael for days after her parents returned home. Deep down, however, Martha felt her mother was right about her deficiencies. Martha's mother pumped Michael for information about Martha when Martha was reluctant to talk. Michael was all too willing to discuss Martha's perceived shortcomings with her mother. [Analysis: Given the striking parallels between the unresolved issues in Michael's relationship with his family, Martha's relationship with her family, and the issues in their marriage, emotional cutoff clearly did not solve any problems. It simply shifted the problems to their marital relationship and to Amy.]

8. Societal Emotional Processes These processes are social expectations about racial and class groups, the behaviours for each gender, the nature of sexual orientation... and their effect on the family. In many ways, this is like The Family Projection Process scaled up to the level of a society as a whole. Families that deal with prejudice, discrimination, and persecution must pass on to their children the ways they learned to survive these factors. The coping practices of the parents and extended family may lead to more or less adaptive emotional health for the family and its members.

Societal Emotional Process Each concept in Bowen theory applies to nonfamily groups, such as work and social organizations. The concept of societal emotional process describes how the emotional system governs behaviour on a societal level, promoting both progressive and regressive periods in a society. Cultural forces are important in how a society functions but are insufficient for explaining the ebb and flow in how well societies adapt to the challenges that face them. Bowen's first clue about parallels between familial and societal emotional functioning came from treating families with juvenile delinquents. The parents in such families give the message, "We love you no matter what you do." Despite impassioned lectures about responsibility and sometimes harsh punishments, the parents give in to the child more than they hold the line. The child rebels against the parents and is adept at sensing the uncertainty of their positions. The child feels controlled and lies to get around the parents. He is indifferent to their punishments. The parents try to control the child but are largely ineffectual. Bowen discovered that during the 1960s the courts became more like the parents of delinquents. Many in the juvenile court system considered the delinquent as a victim of bad parents. They tried to understand him and often reduced the consequences of his actions in the hope of effecting a change in his behaviour. If the delinquent became a frequent offender, the legal system, much like the parents, expressed its disappointment and imposed harsh penalties. This recognition of a change in one societal institution led Bowen to notice that similar changes were occurring in other institutions, such as in schools and governments. The downward spiral in families dealing with delinquency is an anxiety-driven regression in functioning. In a regression, people act to relieve the anxiety of the moment rather than act on principle and a longterm view. A regressive pattern began unfolding in society after World War II. It worsened some during the 1950s and rapidly intensified during the 1960s. The "symptoms" of societal regression include a growth of crime and violence, an increasing divorce rate, a more litigious attitude, a greater polarization between racial groups, less principled decision-making by leaders, the drug abuse epidemic, an increase in bankruptcy, and a focus on rights over responsibilities. Human societies undergo periods of regression and progression in their history. The current regression seems related to factors such as the population explosion, a sense of diminishing frontiers, and the depletion of natural resources. Bowen predicted that the current regression would, like a family in a regression, continue until the repercussions stemming from taking the easy way out on tough issues exceeded the pain associated with acting on a long-term view. He predicted that will occur before the middle of the twenty-first century and should result in human beings living in more harmony with nature. Example: It is more difficult for families to raise children in a period of societal regression than in a calmer period. A loosening of standards in society makes it more difficult for less differentiated parents like Michael and Martha to hold a line with their children. The grade inflation in many school systems makes it easier for students to pass grades with less work. In the litigious climate, if schools try to hold the line on what they can realistically do for their students, they often face lawsuits from irate parents.

The prevalence of drug and alcohol abuse gives parents more things to worry about with their adolescents. The current societal regression is characterized by an increased child focus in the culture. Much anxiety exists about the future generation. Parents are criticized for being too busy with their own pursuits to be adequately available to their children, both to support them and to monitor their activities. When children like Amy report that they feel distant from their parents and alienated from their values, the parents' critics fail to appreciate the emotional intensity that generates such alienation. The critics prod the parents to do more of what they have already been doing. People who advocate more focus on the children cite the many problems young people are having as justification for their position. Using the child's problems as justification for increasing the focus on them is precisely what the child focused parents have been doing all along. An increase in the problems young people are having is part of an emotional process in society as a whole. A more constructive direction would be for people to examine their own contributions to societal regression and to work on themselves rather than focus on improving the future generation.

Normal Family Development To Bowen, all families lie along a continuum. While you might try to classify families as falling into discreet groups, there really are no "types" of families, and most families of one type could become a family of another type if their circumstances changed. In many ways, Bowen was among the first of the culturally sensitive family therapists. Bowen believed that optimal family development occurs when family members are differentiated, feel little anxiety regarding the family, and maintain a rewarding and healthy emotional contact with each other. Fogarty offers that adjusted families • • • • • • • • • •

are balanced in terms of their togetherness and separateness, and can adapt to changes in the environment view emotional problems as coming largely from the greater system but as having some components in the individual member are connected across generations to extended family have little emotional fusion and distance have dyads that can deal with problems between them without pulling others into their difficulties tolerate and support members who have different values and feelings, and thus can support differentiation are aware of influences from outside the family (such as Societal Emotional Processes) as well as from within the family allow each member to have their own emptiness and periods of pain, without rushing to resolve or protect them from the pain and thus prohibit growth preserve a positive emotional climate, and thus have members who believe the family is a good one have members who use each other for feedback and support rather than for emotional crutches

Family Disorders Bowen believed that family problems result from emotional fusion, or from an increase in the level of anxiety in the family. Typically, the member with "the symptom" is the least differentiated member of the family, and thus the one who has the least ability to resist the pull to become fused with another member, or who has the least ability to separate their own thoughts and feelings from those of the larger family. The member "absorbs" the anxiety and worries of the whole family and becomes the most debilitated by these feelings. Families face two kinds of problems. Vertical problems are "passed down" from parent to child. Thus, adults who had cold and distant relationships with their parents do not know how to have warm and close relationships with their children, and so pass down their own problems to their children. Horizontal problems are caused by environmental stressors or transition points in the family development. This may result from traumas such as a chronic illness, the loss of the family home, or the death of a family member. However, horizontal stress may also result from Social Emotional Processes, such as when a minority family moves from a like-minority neighborhood to a very different neighborhood, or when a family with traditional gender roles immigrates to a culture with very different views, and must raise their children there. The worst case for the family is when vertical and horizontal problems happen at once.

Family Therapy with One Person Family therapy can be done with one person. Such therapy typically focuses on differentiation of the person from the family. The therapist helps the individual stop seeing family members in terms of the roles (parent, sibling, caretaker...) they played, and start seeing them as people with their own needs, strengths, and flaws. The individual learns to recognize triangulation, and take some ownership in allowing or halting it when it happens. The individual client should have good insight into the family (genograms may be especially helpful in this), and be very motivated to make changes either in his or her own life, or in the family.

Goals of Therapy Treatment entails • • •

• • • • • •

reframing the presenting problem as a multigenerational problem that is caused by factors beyond the individual lowering anxiety and the "emotional turmoil" that floods the family so they can reflect and act more calmly increasing differentiation, especially of the adult couple, so as to increase their ability to manage their own anxiety, transition more effectively to parenthood, and thus fortify the entire family unit's emotional wellbeing using the therapist as part of a "healthy triangle" where the therapist teaches the couple to manage their own anxiety, distance, and closeness in healthy ways forming relationships with the family member with "the problem" to help them separate from the family and resist unhealthy triangulation and emotional fusion opening closed ties with cut off members focusing on more than "the problem" and including the overall health and happiness of the family evaluating progress of the family in terms of how they function now, as well as how adaptive they can be to future changes addressing the power differential in heterosexual couple based on differences, for example, in economic power and gender role socialization (this is a contribution of those who have reconsidered Bowen's theory through a feminist lens)

In general, the therapist accomplishes this by giving less attention to specific problem they present with, and more attention to family patterns of emotions and relationships, as well as family structures of dyads and triangles. More specifically, the therapist • • •

• • •

•

tries to lower anxiety (which breeds emotional fusion) to promote understanding, which is the critical factor in change; open conflict is prohibited as it raises the family members' anxiety during future sessions remains neutral and detriangulated, and in effect models for the parents some of what they must do for the family promotes differentiation of members, as often a single member can spur changes in the larger family; using "I" statements is one way to help family members separate their own emotions and thoughts from those of the rest of the family develops a personal relationships with each member of the family and encourages family members to form stronger relationships too encourages cut off members to return to the family may use descriptive labels like "pursuer-distancer," and help members see the dynamic occurring; following distancers only causes them to run further away, while working with the pursuer to create a safe place in the relationship invites the distancer back. coaches and consults with the family, interrupts arguments, and models skills...

Techniques Bowen did not believe in a "therapeutic bag of tricks." Questioning the family and constructing a family genogram are the closest things to basic techniques all Bowenian therapists would use. Carter has assigned tasks to the adult couple to help them realize more about their family history, and encourages letter writing to distant members, visiting mother-in-laws... to speed things up. Guerin accepts the family's opinion of who "has the problem" and works from there with a variety of techniques to help all family members own some responsibility for helping that sick member get better. He will also use stories or films to present another real or imaginary family with the same problem as the family in therapy, and highlight how the family in the story or film overcame their difficulties.

Bowenâ&#x20AC;&#x2122;s Strategic Family Therapy - II Murray Bowenâ&#x20AC;&#x2122;s approach operates on the premise that a family can best be understood when it is analyzed from at least a three-generation perspective, because a predictable pattern of interpersonal relationships connects the functioning of family members across generations. According to Bowen, the cause of an individual's problems can be understood only by viewing the role of the family as an emotional unit. A basic assumption in Bowen family therapy is that unresolved emotional fusion (or attachment) to one's family must be addressed if one hopes to achieve a mature and unique personality. Bowen (1966, 1976) identifies eight key concepts as being central to his theory that can be grouped into four areas of assessment: 1) 2) 3) 4)

Spousal relationships de-triangulation (triangulation) differentiation (differentiation of the self, sibling position, emotional cutoff). emotional systems (the nuclear family emotional system, societal regression, the family projection process and the multigenerational transmission process, sibling position),

Of these, the major contributions of Bowen's theory are the core concepts of differentiation of the self and triangulation. He focused on helping families develop individual identities for each member while maintaining a sense of closeness and togetherness with their families.

1) Bowen paid attention to the spousal relationship and the definition and clarification of the couple's relationship. Interrelations emphasized more than components; systemwide ripples ("these cause each other") emphasized more than linearity (this causes that). Whatever its components, unresolved stress between parents reverberates down through all family inter-relations and normally results in coalitions, emotional parent-child alignments against the other parent and perhaps other children. Example: Mom is a rageaholic, so when she explodes, Dad and Brother console one another and perhaps agree that she's nuts. A linear approach would emphasize Mom's upbringing and lack of anger management skills and thereby ignore the coalition process itself and reinforce its tendency to scapegoat, whereas a systems approach would focus on the present-time context of Mom's explosions, looking at the interactions leading up to it and encouraging Dad and Mom to work out new, nonescalating ways to talk and negotiate--perhaps in couples therapy--rather than blaming her or him or failing to confront and defuse alliances forming elsewhere in the family.

2) Triangulation – A situation in which two family members involve a third family member in a conflictual scenario. Bowen considers de-triangulation of self from the family emotional system. Triangulation and Nuclear Family Emotional System. Bowen (1976) notes that anxiety can easily develop within intimate relationships. Under stressful situations, two people may recruit a third person into the relationship to reduce the anxiety and gain stability. This is called triangulation. When tension arises between two people and a third is engaged to relieve the tension it is called triangulation . When tension is greater than what the three person system can handle, a series of interlocking triangles is created. For example, three people create one triangle, four people create four interlocking triangles and five people create nine interlocking triangles etc. Each triangle has two positive sides and one negative side. Bowen (1978) identifies two variables important in determining why triangles occur in relationships. The first is the level of differentiation . This refers to the degree to which individuality is maintained in a system. The second variable is the level of anxiety . This refers to the amount of emotional tension in a system. A low level of differentiation, or a higher level of anxiety produce more triangling. Anticipating and diffusing triangulating maneuvers forces the parties to focus on the problem. Other successful strategies in remaining de-triangled are seriousness and humor.

Although triangulation may lessen the emotional tension between the two people, the underlying conflict is not addressed, and in the long run the situation worsens: What started as a conflict in the couple evolves into a conflict within the nuclear family emotional system. Family Projection Process and Multigenerational Transmission. The most common form of triangulation occurs when two parents with poor differentiation fuse, leading to conflict, anxiety and ultimately the involvement of a child in an attempt to regain stability. When a parent lacks differentiation and confidence in her or his role with the child, the child also becomes fused and emotionally reactive. The child is now declared to “have a problem,” and the other parent is often in the position of calming and supporting the distraught parent. Such a triangle produces a kind of pseudo stability for a while: the emotional instability in the couple seems to be diminished, but it has only been projected onto the child. This family projection process makes the level of differentiation worse with each subsequent generation (Papero, 2000). When a child leaves the family of origin with unresolved emotional attachments, whether they are expressed in emotional fusion or emotional cutoff, they will tend to couple and create a family in which these unresolved issues can be re-enacted. The family projection process has now become the foundation for multigenerational transmission. E.g.: when parents have unresolved and intense conflicts, they may focus on their offspring. Thus one or more children may become problematic as a result of being triangulated into their parents’ relationship. Instead of fighting with each other, the parents are temporarily distracted by riveting their attention on their child(ren). Similarly, the conflict between the parents also may involve the triangulation of the child(ren) as interpreters of one to the other. Thomas Fogarty introduced to Bowen theory a distinction between triangles and triangulation. For him, the former was a structure that existed in all families while the latter was an emotional process. His focus on couples led him to believe that there was directional movement within family triangles that almost always included a pursuer and a distancer.

These were complementary relational positions whereby - the pursuer is someone who wants lots of relational contact, especially during times of stress; - the distancer is less expressive of thoughts and feelings, and often finds comfort in necessary tasks rather than relationship.

3) Differentiation Of The Self and Emotional Cutoff. The cornerstone of Bowen's theory is differentiation of the self, which involves both the psychological separation of intellect and emotion and independence of the self from others. Differentiated individuals are able to choose to be guided by their thoughts rather than their feelings. Undifferentiated people have difficulty in separating themselves from others and tend to fuse with dominant emotional patterns in the family. - These people have a low degree of autonomy, - they are emotionally reactive, and - they are unable to take a clear position on issues: -

they have a pseudo-self.

Self-differentiation was Bowenâ&#x20AC;&#x2122;s principal goal of family therapy. Bowen would model differentiation to his clients by using "I" statements and taking ownership of his own thoughts, feelings, and behaviours. Differentiation â&#x20AC;&#x201C; The ability of an individual to separate rational and emotional selves. Functional families are characterized by each member's success in finding the healthy balance between belonging to a family and maintaining a separate identity. One way to find the balance between family and individual identity is to define and clarify the boundaries that exist between the subsystems. A family may have several subsystems such as a spouse, sibling, and parent-child subsystem. Each subsystem contains its own subject matter that is private and should remain within that subsystem. Boundaries between subsystems range from rigid to diffuse. One of the most common family problems is a weak boundary between subsystems Diffuse boundaries can lead to over-enmeshment. Enmeshment: inappropriate, boundary-violating closeness in which family members are emotionally overreactive to one another Rigid boundaries allow too little interaction between family members, which may result in disengagement. (Disengagement: too much emotional distance between family members.) Overall, human systems tend to work best when subsystem boundaries are clear (neither too open nor too closed), interactions are clear and nonrepetitive, lines of authority are visible, rules are overt and flexible, changing alignments replace rigid coalitions, and stressors are confronted instead of pushed onto scapegoats Families who understand and respect differences between healthy and unhealthy subsystem boundaries and rules function successfully. Families who do not understand and respect these differences find themselves in a dysfunctional state of conflict. People who are fused to their families of origin tend to marry others to whom they can become fused; that is, people at similar levels of differentiation tend to seek out and find each other when coupling. One pseudo-self relies on another pseudo-self for emotional stability.

Unproductive family dynamics of the previous generation are transmitted from one generation to the next through such a marriage (Becvar & Becvar, 2003). In family systems theory, the key to being a healthy person encompasses both a sense of belonging to one's family and a sense of separateness and individuality. Differentiation from the family of origin allows one to accept personal responsibility for one’s thoughts, feelings, perceptions, and actions. Simply leaving one’s family of origin physically or emotionally, however, does not imply that one has differentiated. Indeed, Bowen’s phrase for estrangement or disengagement is emotional cutoff, a strong indication of an undifferentiated self. Individuation, or psychological maturity, is a lifelong developmental process that is achieved relative to the family of origin through reexamination and resolution of conflicts within the individual and relational contexts. The distinction between emotional reactivity and rational thinking can be difficult to discern at times. Those who are not emotionally reactive experience themselves as having a choice of possible responses; their reactions are not automatic but involve a reasoned and balanced assessment of self and others. Emotional reactivity, in contrast, is easily seen in clients who present themselves as paranoid, intensely anxious, panic stricken, or even “head over heels in love.” In these cases, feelings have overwhelmed thinking and reason, and people experience themselves as being unable to choose a different reaction. Emotional reactivity in therapists almost always relates to unresolved issues with family-of-origin members. For example, the sound of a male’s voice in a family session reminds the therapist of his father and immediately triggers old feelings of anger and anxiety as well as an urgency to express them. Clarity of response in Bowen’s theory is marked by a broad perspective, a focus on facts and knowledge, an appreciation of complexity, and a recognition of feelings, rather than being dominated by them: Such people achieve what Bowen sometimes referred to as a solid self (Becvar & Becvar, 2003). 4) Understanding family emotional systems and how they work is central to Bowen's theory. The nuclear emotional process refers to how the family system operates in a crisis. The family projection process refers to how parents pass good and bad things on to their children. The multigenerational transmission process refers to how a family passes its good and baggage between generations Bowen focused on how family members could maintain a healthy balance between being enmeshed (overly involved in each other’s lives) and being disengaged (too much detachment from each other).

Although all family therapists are interested in resolving problems presented by a family and decreasing symptoms, Bowen therapists are mainly interested in changing the individuals within the context of the system. They contend that problems that are manifest in one's current family will not significantly change until relationship patterns in one's family of origin are understood and addressed. Emotional problems will be transmitted from one generation to the next until unresolved emotional attachments are dealt with effectively. Change must occur with other family members and cannot be done by an individual in a counseling room. Living systems and all the other system-related processes--move forward through key "horizontal" transitional stages (brought about by time and change). Symptoms occur when vertical stressors (old issues, past mistakes, emotional legacies) impinge on the system during a transition.

Families are likeliest to be conflicted and symptomatic when key horizontal transitions like marriage, the birth of children, children going to school, children moving away from home, changes of jobs, etc. coincide with a resurfacing of vertical stressors like old emotional baggage. Example: a workaholic husband driven to succeed by high internalized standards that equate esteem with production (vertical stressor) puts in even more overtime to stuff the loneliness he feels when his eldest son leaves for college (horizontal stressor). In this case, part of the therapeutic agenda would include giving the family tools for negotiating the "empty nest syndrome" while helping the husband get in touch with his mourning, examine his expectations of himself, and reconnect with his family. Calibration: setting of a present-oriented, systemwide range limit around a comfortable emotional "bias." A typical situation: an unintense family with a cool emotional atmosphere unconsciously selects a member to turn up the heat; brother and sister start fighting. This turns into an argument between the parents, the drama escalates, and then, before it gets too hot, a child who plays the role of family ambassador calms everybody down. In that family the bias, the emotional level setting, is too low; a good dose of constructive intensity might recalibrate the bias and make explosions unnecessary. Self-regulating via feedback loops--negative (toward stability) and positive (toward change)--that maintain the bias. Every seasoned drug and alcohol counsellor knows that when one member of the family stops drinking or using, the family will subtly try to push him back into his old vices--not because they want him sick, but because families, like other organisms, naturally resist changes that might further destabilize the system. So one day the husband says to his abstaining wife, "Why not skip your AA meeting tonight so we can catch a movie?" Or the mother of a teen who's quit using congratulates him on finding a job--in a head shop. Introducing positive (= system-changing) feedback loops into these families might include warning them about enabling, relapses and resistance to change and examining what family members gain from having a malfunctioning member (control? A scapegoat? Distraction from other conflicts? Someone to rescue?). Sibling Position. Bowen adopted Tomanâ&#x20AC;&#x2122;s (1993) conceptualization of family constellation and sibling (or birth) position. Toman believed that position determined power relationships, and gender experience determined oneâ&#x20AC;&#x2122;s ability to get along with the other sex. In addition to noting the unique positions of only children and twins, Toman focused on ten power/sex positions: 1. the oldest brother of brothers; 2. the youngest brother of brothers; 3. the oldest brother of sisters; 4. the youngest brother of sisters; 5. the male only child; 6 â&#x20AC;&#x201C; 10 and the same five configurations for females in relation to sisters and brothers. Under this conceptualization, the best possible marriage, for example, is hypothesized to be the oldest brother of sisters marrying the youngest sister of brothers; in this arrangement, both parties would enter the marriage with similar expectations about power and gender relationships. Conversely, the worst marriage would occur between the oldest brother of brothers and the oldest sister of sisters. In this case, both parties would seek and want power

positions, and neither would have had enough childhood experience with the other sex to have adequate gender relationships. Toman supported his hypothesis by noting that the divorce rate among couples comprised of two oldest children was higher than any other set of birth positions. The absence of divorce, however, is not the same as a happy marriage. When we consider the critical traits in a happy marriage, his predictions based on birth order start to lose credibility. Happiness in coupling or marriage is demonstrably more related to attitudinal and behavioural interactions within the spousal system—especially during periods of family stress—than to birth order (Gottman, 1994, Walsh, 2003). Guerin (2002) discussed the importance of what he called the “sibling cohesion factor” (p. 135), especially when there were more than two children in the sibling subsystem, allowing for triangles to form. The sibling cohesion factor is the capacity of the children within the sibling subsystem to meet without their parents and discuss important family issues, including their evaluation of their parents. Healthier families tend to have this factor as part of the family process; the lack of it suggests to Guerin that there is intense triangulation between the parents and children. The practice of Bowen family therapy is governed by the following two goals: (1) lessening of anxiety and symptom relief and (2) an increase in each family member's level of differentiation of the self (Kerr & Bowen, 1988). To bring about significant change in a family system, it is necessary to open closed family ties and to engage actively in a detriangulation process (Guerin, Fogarty, Fay, & Kautto, 1996). Although problems are seen as residing in the system rather than in the individual, the route to changing oneself is through changing in relationship to others in the family of origin. Bowen encouraged his clients to come to know others in their family as they are. He helped individuals or couples gather information, and he coached or guided them into new behaviours by demonstrating ways in which individuals might change their relationships with their parents, siblings, and extended family members. He instructed them how to be better observers and also taught them how to move from emotional reactivity to increased objectivity. He did not tell clients what to do, but rather asked a series of questions that were designed to help them figure out their own role in their family emotional process. Other concepts: Emotional divorce (like when a sick child holds the parents together); theory is important; no one ever really leaves the family system; mother-child symbiosis when unresolved predisposes to schizophrenia; solid self vs. pseudoself; over- underadequate reciprocity. Two natural forces: growth of individual and emotional connection. Emphasized the first. Fusion breeds anxiety and increases emotional reactivity. Three outcomes of fusion: physical or mental dysfunction in a spouse; in a child; chronic marital conflict. Dysfunctional reciprocal relationships: include overadequate/underadequate, decisive/indecisive, dominant/submissive, hysterical/obsessive, schizoid/conflict, or cutoff between spouses.

MORE ABOUT TRIANGLES 1. Cross-generational coalitions (i.e. mother-father-child triangles) are associated with child behaviour problems. In studies of adolescent antisocial behaviour, differences in dyadic interaction between families with a child with behaviour problems and families with a well adjusted child have been evaluated. Empirical studies show that on average: •

Children with behaviour problems are more aligned with their mothers and more disengaged from their fathers than are the well-adjusted adolescents.

•

Parents of children with behaviour problems have more discordant relations than the parents of well-adjusted adolescents.

•

Within families of well-adjusted adolescents, the parents are more supportive of each other than the adolescent.

This suggests that strengthening the parental dyad through the resolution of marital problems, and promoting more positive father-adolescent relations will weaken the cross-generational coalition and ameliorate the symptomatic behaviour. In another study , the family triangle was defined as a family systems construct used to describe family communication patterns in which a dyad cannot cope with demands for intimacy or conflict resolution. As such, triangles occur to reduce tension between two people, but are problematic because they do not provide solutions.

2. The authors reviewed three family triangles: •

Triangulation: occurs when a parent demands that a child side with her or him against the other parent.

•

Detouring: occurs when spouses ignore the issues in their own relationship and focus on the child's issues.

•

Cross-generational coalition: exists when one parent sides with a child against another parent. This differs from triangulation because it is the parent who initiates the coalition and the attachment between the parent and the child exceeds that between the parents.

All three family triangles are considered to have negative developmental effects on the child. •

• • •

They create a false sense of attachment and security and do not give the child the opportunity to develop a healthy separate identity. For this reason the study considers the "impact of cross-generational coalitions on interpersonal intimacy and view intimacy as a developmental task relevant to young adults" Children with a cross-generational attachment have larger intellectual-intimacy, emotional-intimacy and sexual-intimacy discrepancy scores. Cross-generational coalitions also affect the ability to successfully negotiate psycho-social developmental tasks. Tests reveal that, even while away from home, children are still affected by the family triangle. "Detriangulating" can contribute considerably in resolving intimacy issues. Detriangulating involves: a) not talking with one parent about the other parent, b) teaching the client about triangulation patterns, c) the client becoming more objective and less emotional with his or her parents.

Because the family is not a static entity, a change in one part of the system affects the actions of all others involved. Bowen sometimes worked with one member of a conflictual dyad (or couple). He did not require that every family member be involved in the therapy sessions. Bowen tended to work from the inside out: Starting with the spousal relationship, he helped the two adults establish their own differentiation. As a therapist, he attempted to maintain a stance of neutrality. If the therapist becomes emotionally entangled with any one family member, the therapist loses effectiveness and becomes part of a triangulated relationship. Bowen maintains that, to be effective, family therapists have to have a very high level of differentiation. If therapists still have unresolved family issues and are emotionally reactive, they are likely to revisit those difficulties in every family they see.

3. Vogel, E.F. and Bell, N.W. (1968). The Emotionally Disturbed Child as the Family Scapegoat. The purpose of this study was to learn more about how "the emotionally disturbed child used as a scapegoat for the conflicts between parents and what the functions and dysfunctions of this scapegoating are for the family." (p. 412) When parents experience crises for which they have no adequate coping mechanisms, they look for ways to discharge some of the tension. One of the most common methods is to involve a third person. When the third person is their child, parents often project their problems on to the child. They focus their attentions on the problems of the child so they can avoid the pain of admitting their own problems. This is what Vogel and Bell call "scapegoating". There were many reasons why the child was selected as the scapegoat. • • • • •

First, the child was relatively powerless to leave the family nor to counter the parents triangulation. The child's personality is very flexible and adopts quickly to the assigned role of scapegoat. The child has few task which are vital in the maintenance of the family. "The cost in dysfunction of the child is low relative to the functional gains for the whole family." Often, the chosen child would best symbolize the parental conflicts. For example, if the conflict was over achievement, the child who stood out most (for either over- or under-achieving) would be targeted. Children were also picked because they possessed the same undesirable traits (either physically, behaviourally or emotionally) as the parent. The study also found that the scapegoated child had a (considerably) lower IQ than the other children. Many had physical abnormalities. All of the parents reported having had tensions since early in the marriage.

Once the child is selected she or he must carry out the role of the problem child. The authors found that the problem behaviour was reinforced through inconsistent parenting. The dysfunction would be both supported and criticized. In some cases, parents would encourage opposing types of behaviour. In other instances parents promoted different norms. This set up a self-perpetuating cycle which "normalized" the child's problems. The dysfunction became part of the family. The families used rationalizations to maintain the equilibrium attained when the child took on the parents' problems. •

One rationalization was that the parents, rather than the children, were the victims.

•

Another was to emphasize how fortunate the child was, because their life was better than the parents. The parents felt justified in depriving the children of things they wanted and then used the complaints to reinforce the scapegoating.

â&#x20AC;˘

Another common belief was that the child could behave if she or he wanted to. This rationalized sever punishment.

The authors point out that there are both functions and dysfunctions of scapegoating. â&#x20AC;˘

â&#x20AC;˘

For the parents, scapegoating serves to stabilize their relationship. They were also better able to live up to the societal expectations of a happy marriage. Scapegoating permits the family to maintain its solidarity. At the same time, communities can scapegoat the family with the dysfunctional child. One of the dysfunctions is that scapegoating creates "realistic problems and extra tasks" for the family. Another is that the child often becomes very adept at fighting back and usually directs their aggression towards the everpresent mother.

4. Marks, S. (1989). Towards a systems theory of marital quality. Marks (1989) suggests that relationships can be understood in terms of two intersecting triangles. He has borrowed Margaret Mead's concept of "I" and "me" in describing the nature of the triangle. The "I" is the presentation of the self at that moment or in that situation. This contrasts with the "me" which is an organization of tendencies. The situation brings the "I" out of the "me". The triangle is three points and those can be understood as three tendencies, or three "me" corners. At any given moment one corner will be the focus of energy. That corner will then be the "I", the present manifestation of the tendencies. In therapy, the placement of the"I" structures the future. Each triangle has three corners. 1) The first corner is the Inner-self (I-corner), the driving force. 2) The second is the Partnership (P-corner) corner. This coordinates the self with a primary partner. 3) The third corner is any area where the self concentrates energy that is different from the first two corners, eg job, children, religion, friends etc. Marks' conception differs from Bowen's view of triangles in marriage. Bowen sees the couple as two corners of the triangle. The couple uses the third corner as a buffer against their tension. The third corner provides a distraction and relieves the marital pressure. In a marital therapy situation, the therapist can act as the third corner. The "Three Corners" model is a systems theory of the self in marriage. A traditional concept in marriage therapy is "marital quality". Marks states "Quality of marriage is a consequence of the way married selves are systematically organized. A person whose "I" maintains some regular motion around and between all three corners has a high quality marriage." The article introduces seven different manifestations of the dual triangle construct. The first three are low quality relationships. These are characterized by a concentration of energy on one corner without a flow of energy to all parts. 1) The first triangle is the "Romantic Fusion", wherein all the energy is focused on the P . This is the traditional beginnings of a relationship. This becomes unhealthy after a while because other areas of the self are neglected. 2) The second is the "Dependency-Distancing" relationship. This is a traditional unhealthy female-male situation where the woman places energy on the partner and the partner (the man) places energy on the 3rd corner, usually work. 3) The third is the "Separated" relationship where both people focus their energy on their 3rd corner. Marks says that while this can be very healthy and stable, as a marriage is concerned it is low quality.

The last four triangles represent high quality marriages. There is a radical shift in the conception of the triangle. Because there is a constant flow of energy, the three points are connected by rounded lines, making a circle. This represents uninterrupted energy flow between the "me's". In a high quality marriage there is a multiplicity of healthy connections which are as dynamic and fluid as the energy. 4) The fourth is the "Balanced Connection" which has an equal concentration of energy. 5) The fifth is "Couple Centered". The energy is focused on the P , but differs from the second triangle in that the other "me's" receive energy. 6) The sixth is "Family Centered". Both people focus their energy on the family, which would be a joint 3rd interest. 7) The seventh is "Loose". The energy is focused on the 3rd , without detriment to the stability of the couple because, again, there is a steady flow of energy to the other corners.

Marks' (1989) concept of the self as a triangle is very useful and deserves more attention. A useful application would be in Slater's (1994) article on triangles in committed lesbian relationships. In his article, Marks does not discuss the possibility of energy revolving around the "I". This might reflect an assumption that there is a sufficient concentration on the "I" naturally, that the inner-self is the base of all the external interactions. This assumes a degree of differentiation that, developmentally, is traditionally more male than female. Slater points out that the affected partner needs consolidate her sense of identity and perceive it as originating within herself. This would result in the "I" in Marks' model to be the focus of energy. Without this option, the therapist would concentrate the affected partner on the "P" and miss the opportunity for individual growth. Criticisms on the triangle theory As exciting and varied as triangle theory is, there are valid criticisms. One is that the majority of the studies focused on dependence as being the dominant catalyst for problems. A good example is West (1986) who states : â&#x20AC;&#x153;In this enmeshed situation the child seems to experience a distorted sense of attachment, involvement, or belonging with the family and fails to experience a secure sense of separateness, individuality or autonomy. â&#x20AC;&#x153; This implies that independence is more important than attachment, and given what we know about gender roles, that male characteristics are more important than female characteristics. The possible gender bias could be addressed by a study on the role of an overly-detached family member on the creation of triangles. This would look at the role that stereotypical male behaviour has on the other two members.

Salvador Minuchin’s Structural family therapy I From Wikipedia, the free encyclopedia Structural Family Therapy (SFT) is a method of psychotherapy developed by Salvador Minuchin which addresses problems in functioning within a family. Structural Family Therapists strive to enter, or "join", the family system in therapy in order to understand the invisible rules which govern its functioning, map the relationships between family members or between subsets of the family, and ultimately disrupt dysfunctional relationships within the family, causing it to stabilize into healthier patterns.[1] Minuchin contends that pathology rests not in the individual, but within the family system. SFT utilizes, not only a unique systems terminology, but also a means of depicting key family parameters diagrammatically. Its focus is on the structure of the family, including its various substructures. In this regard, Minuchin is a follower of systems and communication theory, since his structures are defined by transactions among interrelated systems within the family. He subscribes to the systems notions of wholeness and equifinality, both of which are critical to his notion of change. An essential trait of SFT is that the therapist actually enters, or "joins", with the family system as a catalyst for positive change. Joining with a family is a goal of the therapist early on in his or her therapeutic relationship with the family.

Contents • • • •

1 Family Rules 2 Therapeutic Goals and Techniques 3 See also 4 References

Family Rules In SFT, family rules are defined as an invisible set of functional demands that persistently organizes the interaction of the family. Important rules for a therapist to study include coalitions, boundaries, and power hierarchies between subsystems.[1] According to Minuchin, a family is functional or dysfunctional based upon its ability to adapt to various stressors[2] (extra-familial, idiosyncratic, developmental), which, in turn, rests upon the clarity and appropriateness of its subsystem boundaries. Boundaries are characterized along a continuum from enmeshment through semi-diffuse permeability to rigidity. Additionally, family subsystems are characterized by a hierarchy of power, typically with the parental subsystem "on top" vis-à-vis the offspring subsystem. In healthy families, parent-children boundaries are both clear and semi-diffuse, allowing the parents to interact together with some degree of authority in negotiating between themselves the methods and goals of parenting. From the children’s side, the parents are not enmeshed with the children, allowing for the degree of autonomous sibling and peer interactions that produce socialization, yet not so disengaged, rigid, or aloof, ignoring childhood needs for support, nurturance, and guidance. Dysfunctional families exhibit mixed subsystems (i.e., coalitions) and improper power hierarchies, as in the example of an older child being brought in to the parental subsystem to replace a physically or emotionally absent spouse.

Therapeutic Goals and Techniques Minuchin’s goal is to promote a restructuring of the family system along more healthy lines, which he does by entering the various family subsystems, "continually causing upheavals by intervening in ways that will produce unstable situations which require change and the restructuring of family organization... Therapeutic change cannot occur unless some pre-existing frames of reference are modified, flexibility introduced and new ways of functioning developed."[citation needed] To accelerate such change, Minuchin manipulates the format of the therapy sessions, structuring desired subsystems by isolating them from the remainder of the family, either by the use of space and positioning (seating) within the room, or by having non-members of the desired substructure leave the room (but stay involved by viewing from behind a one-way mirror). The aim of such interventions is often to cause the unbalancing of the family system, in order to help them to see the dysfunctional patterns and remain open to restructuring. He believes that change must be gradual and taken in digestible steps for it to be useful and lasting. Because structures tend to self-perpetuate, especially when there is positive feedback, Minuchin asserts that therapeutic change is likely to be maintained beyond the limits of the therapy session. One variant or extension of his methodology can be said to move from manipulation of experience toward fostering understanding. When working with families who are not introspective and are oriented toward concrete thinking, Minuchin will use the subsystem isolation—one-way mirror technique to teach those family members on the viewing side of the mirror to move from being an enmeshed participant to being an evaluation observer. He does this by joining them in the viewing room and pointing out the patterns of transaction occurring on the other side of the mirror. While Minuchin doesn’t formally integrate this extension into his view of therapeutic change, it seems that he is requiring a minimal level of insight or understanding for his subsystem restructuring efforts to "take" and to allow for the resultant positive feedback among the subsystems to induce stability and resistance to change. Change, then, occurs in the subsystem level and is the result of manipulations by the therapist of the existing subsystems, and is maintained by its greater functionality and resulting changed frames of reference and positive feedback.

Related reading •

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Calgary Women's Emergency Shelter. (2007). Honouring Resistance: How Women Resist Abuse in Intimate Relationships (formerly Resistance to Violence and Abuse in Intimate Relationships: A Response-Based Perspective) Available from Calgary Women's Emergency Shelter, P.O. Box 52051 Edmonton Trail N., Calgary, Alberta T2E 8K9. Coates, L. & Wade, A. (2004). Telling It Like It Isn’t: Obscuring Perpetrator Responsibility for Violent Crime. Discourse and Society, 15(5), 3-30. Coates, L. & Wade, A. (2007). Language and Violence: Analysis of Four Discursive Operations. Journal of Family Violence, 22(7), 511-522. Maddeaux-Young, H. N. (2006). Therapeutic Responses To Violence: A Detailed Analysis Of Therapy Transcripts. Master of Arts Thesis, University of Lethbridge, Department of Sociology.[1]. Renoux, M. & Wade, A. (2008, June). Resistance to Violence: A Key Symptom of Chronic Mental Wellness. Context, 98, 2-4. Todd, N. and Wade, A. (2001). The Language of Responses Versus the Language of Effects: Turning Victims into Perpetrators and Perpetrators into Victims, unpublished manuscript, Duncan, British Columbia, Canada. Todd, N. & Wade, A. (2003). 'Coming to Terms with Violence and Resistance: From a Language of Effects to a Language of Responses', in T. Strong & D. Pare (eds), Furthering Talk: Advances in the Discursive Therapies, New York: Kluwer Academic Plenum. Wade, A. (1997). Small Acts of Living: Everyday Resistance to Violence and Other Forms of Oppression, Journal of Contemporary Family Therapy, 19, 23–40. Wade, A. (1999). Resistance to Interpersonal Violence: Implications for the practice of therapy. University of Victoria, Ph.D. Dissertation, Department of Psychology. Wade, A. (2007a). Despair, resistance, hope: Response-based therapy with victims of violence. In C. Flaskas, I. McCarthy, and J. Sheehan (Eds.), Hope and despair in narrative and family therapy: Adversity, forgiveness and reconciliation (pp. 63–74). New York , NY : Routledge/Taylor & Francis Group. HF Wade, A. (2007b). Coming to Terms with Violence: A Response-Based Approach to Therapy, Research and Community Action. Yaletown Family Therapy: Therapeutic Conversations. [2] Weaver, J., Samantaraya, L., & Todd. N. (2005). The Response-Based Approach in Working with Perpetrators Of Violence: An Investigation. Calgary Women's Emergency Shelter [3]

Narrative Family Therapy - I From Wikipedia, the free encyclopedia Narrative Therapy is a form of psychotherapy using narrative. It was initially developed during the 1970s and 1980s, largely by Australian Michael White and his friend and colleague, David Epston, of New Zealand. Their approach became prevalent in North America with the 1990 publication of their book, Narrative Means to Therapeutic Ends,[1] followed by numerous books and articles about previously unmanageable cases of anorexia nervosa, ADHD, schizophrenia, and many other problems. In 2007 White published Maps of Narrative Practice,[2] a presentation of six kinds of key conversations.

Contents • •

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1 Overview 2 Narrative therapy topics o 2.1 Concept o 2.2 Narrative approaches o 2.3 Common elements o 2.4 Method o 2.5 Outsider Witnesses 3 Criticisms of Narrative Therapy 4 See also 5 References 6 External links

Overview The term "narrative therapy" has a specific meaning and is not the same as narrative psychology, or any other therapy that uses stories. Narrative therapy refers to the ideas and practices of Michael White, David Epston, and other practitioners who have built upon this work. The narrative therapist focuses upon narrative and situated concepts in the therapy. The narrative therapist is a collaborator with the client in the process of discovering richer (or "thicker") narratives that emerge from disparate descriptions of experience, thus destabilizing the hold of negative ("thin") narratives upon the client. By conceptualizing a non-essentialized identity, narrative practices separate persons from qualities or attributes that are taken-for-granted essentialisms within modernist and structuralist paradigms. This process of externalization[1] allows people to consider their relationships with problems, thus the narrative motto: “The person is not the problem, the problem is the problem.” So-called strengths or positive attributes are also externalized, allowing people to engage in the construction and performance of preferred identities. Operationally, narrative therapy involves a process of deconstruction and "meaning making" which are achieved through questioning and collaboration with the client. While narrative work is typically located within the field of family therapy, many authors and practitioners report using these ideas and practices in community work,[3] schools [4][5] and higher education [6] Although narrative therapists may work somewhat differently (for example, Epston uses letters and other documents with his clients, though this particular practice is not essential to narrative therapy), there are several common elements that might lead one to decide that a therapist is working "narratively" with clients.

Narrative therapy topics Concept Narrative therapy holds that our identities are shaped by the accounts of our lives found in our stories or narratives. A narrative therapist is interested in helping others fully describe their rich stories and trajectories, modes of living, and possibilities associated with them. At the same time, this therapist is interested in co-investigating a problem's many influences, including on the person himself and on their chief relationships. By focusing on problems' effects on people's lives rather than on problems as inside or part of people, distance is created. This externalization or objectification of a problem makes it easier to investigate and evaluate the problem's influences. Another sort of externalization is likewise possible when people reflect upon and connect with their intentions, values, hopes, and commitments. Once values and hopes have been located in specific life events, they help to “reauthor” or “re-story” a person's experience and clearly stand as acts of resistance to problems. The term “narrative” reflects the multi-storied nature of our identities and related meanings. In particular, reauthoring conversations about values and re-membering conversations about key influential people are powerful ways for people to reclaim their lives from problems. In the end, narrative conversations help people clarify for themselves an alternate direction in life to that of the problem, one that comprises a person's values, hopes, and life commitments.

Narrative approaches Briefly, narrative approaches hold that identity is chiefly shaped by narratives or stories, whether uniquely personal or culturally general. Identity conclusions and performances that are problematic for individuals or groups signify the dominance of a problem-saturated story. Problem-saturated stories gain their dominance at the expense of preferred, alternative stories that often are located in marginalized discourses. These marginalized knowledges and identity performances are disqualified or invisibilized by discourses that have gained hegemonic prominence through their acceptance as guiding cultural narratives. Examples of these subjugating narratives include capitalism; psychiatry/psychology; patriarchy; heterosexism; and Eurocentricity. Furthermore, binaries such as healthy/unhealthy; normal/abnormal; and functional/dysfunctional ignore both the complexities of peoples’ lived experiences as well as the personal and cultural meanings that may be ascribed to their experiences in context.

Common elements Common elements in narrative therapy are: • • •

• •

•

The assumption that narratives or stories shape a person's identity, as when a person assesses a problem in their life for its effects and influences as a "dominant story"; An appreciation for the creation and use of documents, as when a person and a counsellor co-author "A Graduation from the Blues Certificate"; An "externalizing" emphasis, such as by naming a problem so that a person can assess its effects in her life, come to know how it operates or works in her life, relate its earliest history, evaluate it to take a definite position on its presence, and in the end choose their relationship to it. A focus on "unique outcomes" (a term of Erving Goffman) or exceptions to the problem that wouldn't be predicted by the problem's narrative or story itself. A strong awareness of the impact of power relations in therapeutic conversations, with a commitment to checking back with the client about the effects of therapeutic styles in order to mitigate the possible negative effect of invisible assumptions or beliefs held by the therapist.

Responding to personal failure conversations [7] 79

Method In Narrative therapy a person's beliefs, skills, principles, and knowledge in the end help them regain their life from a problem. In practice a narrative therapist helps clients examine, evaluate, and change their relationship to a problem by acting as an â&#x20AC;&#x153;investigative reporterâ&#x20AC;? who is not at the centre of the investigation but is nonetheless influential; that is, this therapist poses questions that help people externalize a problem and then thoroughly investigate it. Intertwined with this problem investigation is the uncovering of unique outcomes or exceptions to its influences, exceptions that lead to rich accounts of key values and hopesâ&#x20AC;&#x201D;in short, a platform of values and principles that provide support during problem influences and later an alternate direction in life. The narrative therapist, as an investigative reporter, has many options for questions and conversations during a person's effort to regain their life from a problem. These questions might examine how exactly the problem has managed to influence that person's life, including its voice and techniques to make itself stronger. On the other hand, these questions might help restore exceptions to the problem's influences that lead to naming an alternate direction in life. Here the narrative therapist relies on the premise that, though a problem may be prevalent and even severe, it has not yet completely destroyed the person. So, there always remains some space for questions about a person's resilient values and related, nearly forgotten events. To help retrieve these events, the narrative therapist may begin a related re-membering conversation about the people who have contributed new knowledges or skills and the difference that has made to someone and vice-versa for the remembered, influential person.

Outsider Witnesses In this particular narrative practice or conversation, outsider witnesses are invited listeners to a consultation. Often they are friends of the consulting person or past clients of the therapist who have their own knowledge and experience of the problem at hand. During the first interview, between therapist and consulting person, the outsider listens without comment. Then the therapist interviews them with the instructions not to critique or evaluate or make a proclamation about what they have just heard, but instead to simply say what phrase or image stood out for them, followed by any resonances between their life struggles and those just witnessed. Lastly, the outsider is asked in what ways they may feel a shift in how they experience themselves from when they first entered the room[8] Next, in similar fashion, the therapist turns to the consulting person, who has been listening all the while, and interviews them about what images or phrases stood out in the conversation just heard and what resonances have struck a chord within them. In the end, an outsider witness conversation is often rewarding for witnesses. But for the consulting person the outcomes are remarkable: they learn they are not the only one with this problem, and they acquire new images and knowledge about it and their chosen alternate direction in life. The main aim of the narrative therapy is to engage in people's problems by providing the alternative best solution.

Criticisms of Narrative Therapy To date, there have been several formal criticisms of Narrative Therapy over what are viewed as its theoretical and methodological inconsistencies, among various other concerns.[9][10][11] •

•

Narrative therapy has been criticised as holding to a social constructionist belief that there are no absolute truths, but only socially sanctioned points of view, and that Narrative therapists therefore privilege their client's concerns over and above "dominating" cultural narratives.[10][12] Several critics have posed concerns that Narrative Therapy has made gurus of its leaders, particularly in the light that its leading proponents tend to be overly harsh about most other kinds of therapy.[10][12] Others have criticized Narrative Therapy for failing to acknowledge that the individual Narrative therapist may bring personal opinions and biases into the therapy session.[10] Narrative therapy is also criticized for the lack of clinical and empirical studies to validate its many claims.[13] Etchison & Kleist (2000) state that Narrative Therapy's focus on qualitative outcomes is not congruent with larger quantitative research and findings which the majority of respected empirical studies employ today. This has led to a lack of research material which can support its claims of efficacy.[13]

See also Theoretical foundations • • • • •

Constructivist epistemology Feminism Hermeneutics Postmodernism Poststructuralism

Related types of therapy • • • •

Brief therapy Family therapy Response based therapy Solution focused brief therapy

Other related concepts • • •

Dialogical self Lucid dream Questioning

References 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13.

^ a b White, M. & Epston, D. (1990). Narrative means to therapeutic ends. New York: WW Norton. ^ White, M. (2007). Maps of narrative practice. NY: W.W. Norton. ^ Dulwich Centre, 1997, 2000 ^ Winslade, John & Monk, Gerald. (2000) Narrative Mediation: A New Approach to Conflict Resolution. San Francisco: Jossey-Bass. ISBN 0-7879-4192-1 ^ (Lewis & Chesire, 1998) ^ (Nylund and Tilsen, 2006). ^ Narrative Means to Therapeutic Ends; Maps of Narrative Practice; White, M. (2000). Reflections on Narrative Practice Adelaide, South Australia: Dulwich Centre Publications ^ White, M. (2005). Narrative practice and exotic lives: Resurrecting diversity in everyday life. Adelaide: Dulwich Centre Publications. pp 15. ^ Fish, V., Post Structuralism in Family Therapy: Interrogating the Narrative/Conversational Mode. Journal of Family Therapy 19(3) 221-232 (1993) ^ a b c d Minuchin, S., Where is the Family in Narrative Family Therapy? Journal of Marital and Family Therapy, 24(4), 397-403 (1998) ^ Madigan, S., The Politics of Identity: Considering Community Discourse In The Externalizing of Internalized Problem Conversations, Journal of Systemic Therapies, 15(1), 47-62 (1996) ^ a b Doan, R.E., The King is Dead: Long Live the King: Narrative Therapy and Practicing What We Preach, Family Process 37(3), 379-385 (1998) ^ a b Etchison, M., & Kleist, D.M, Review of Narrative Therapy: Research and Review, Family Journal 8(1) 61-67 (2000)

Narrative Family Therapy - II We do not tell stories only: we are stories. Storytelling is now emerging as a critical component of Scottsdale family therapy. There are now quite a number of Scottsdale therapists who have gained positive results in their sessions with individuals facing varied family issues. It is essential that we spend some time and understand some important principles that come into play when storytelling is adopted as a major element of the family therapy approach. Storytelling as a major element of family therapy relays ideas and messages holistically. As a result to this, the listeners are able to receive the message in a simple, logical manner and in one single flow. Storytelling is considered as an age-old form of expressing ideas and emotions. This type of communication is the native language which can be used with persons as young as two years of age. On the other hand, the abstract form of communication becomes effective only to individuals who are at least 8 years old. This method of communication allows the family therapist to communicate in a way that allows him to sort out the elements in logical sequence out from a chaotic setting. This approach connects the individual to time and space, and the direction of the sequence of events becomes clearer enabling the therapist to deliver a more sensible idea or message. Family therapists are able to deliver holistic realities once they adopt storytelling as an integral part of the therapy sessions as opposed to abstract method of communication which normally breaks down the message into fragments. Abstract type of communication forces on our perceived time and space and sets its own framework and applies such mental framework to another individual. What happens to such type of therapy is that the person is limited to just two options- accepting or rejecting the idea relayed by the family therapist. With the abstract communication approach, one ends up with a yes-no, all or nothing type of confrontation. By contrast, storytelling comes out as a collaborative encounter which encourages the listener to participate in an arm-in-arm activity with the family therapist. This narrative element of family therapy is more of a rhythmic dance rather than a communication struggle. What makes this narrative approach a truly effective adjunct of the entire family therapy procedure is that it allows the listener create a parallel event in his own consciousness. This increases the possibility of acceptance more than the rejection that we normally experience in the abstract type of communication. Another critical aspect of storytelling has something to do with tacit knowledge. We know more things than we actually believe we have and it is important to acknowledge the importance of tacit knowledge in the overall scheme of things. Finally, abstract type of communication is in general described as dry and dull because individuals struggle to relate it to reality. As living creatures with unique characteristics we are easily attached to things that are animate and reject inert and inanimate things like abstracted concepts. Individuals always consider the experience of storytelling as lively and entertaining. It is one great way we can accept ideas as it is presented explicitly by a competent family therapist. White, Michael: people's lives are organized by their life narratives. We become the stories we tell about our own experience. Replace unhelpful stories with helpful ones.

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DEFINITIONS The identified patient The identified patient (IP) is the family member with the symptom that has brought the family into treatment. Children and adolescents are frequently the IP in family therapy. The concept of the IP is used by family therapists to keep the family from scapegoating the IP or using him or her as a way of avoiding problems in the rest of the system. Homeostasis (Balance) Homeostasis means that the family system seeks to maintain its customary organization and functioning over time, and it tends to resist change. The family therapist can use the concept of homeostasis to explain why a certain family symptom has surfaced at a given time, why a specific member has become the IP, and what is likely to happen when the family begins to change. The extended family field. The extended family field includes the immediate family and the network of grandparents and other relatives of the family. This concept is used to explain the intergenerational transmission of attitudes, problems, behaviours, and other issues. Children and adolescents often benefit from family therapy that includes the extended family. Differentiation Differentiation refers to the ability of each family member to maintain his or her own sense of self, while remaining emotionally connected to the family. One mark of a healthy family is its capacity to allow members to differentiate, while family members still feel that they are members in good standing of the family. Triangular relationships Family systems theory maintains that emotional relationships in families are usually triangular. Whenever two members in the family system have problems with each other, they will "triangle in" a third member as a way of stabilizing their own relationship. The triangles in a family system usually interlock in a way that maintains family homeostasis. Common family triangles include a child and his or her parents; two children and one parent; a parent, a child, and a grandparent; three siblings; or, husband, wife, and an in-law. Multisystemic Therapy In the early 2000s, a new systems theory, multisystemic therapy (MST), has been applied to family therapy and is practiced most often in a home-based setting for families of children and adolescents with serious emotional disturbances. MST is frequently referred to as a "family-ecological systems approach" because it views the family's ecology, consisting of the various systems with which the family and child interact (for example, home, school, and community). Several clinical studies have shown that MST has improved family relations, decreased adolescent psychiatric symptoms and substance use, increased school attendance, and decreased re-arrest rates for adolescents in trouble with the law. In addition, MST can reduce out-of-home placement of disturbed adolescents. Calibration: Setting of a range limit (bias) in a system, like a thermostat in a room. The limit of how much change a family will tolerate. (Bias: a family's emotional thermostat. The therapist needs to look into who has the power to reset it.) Family Life Cycle: Just like an individual, a family has developmental tasks and key (second-order) transitions like leaving home, joining of families through marriage, families with young children (the key milestone, and one that initiates vertical realignment), families with adolescents, launching children and moving on, families in later life. Key question: "How well did the family do on its last assignment?" Horizontal stressors are those involving these transitional assignments; vertical stressors are transmitted mainly via multigenerational triangling. Symptoms tend to occur when horizontal and vertical stressors intersect. Divorce adds extra developmental steps for all involved families.

Centrifugal/centripetal: Tendency of family members to move toward or away from a family. Circular (mutual, reciprocal) causality: When things cause each other rather than just one causing the other (linear causality). Emphasizes present, process over past, content. Open/Closed systems: Open: Those that embrace new information and display negentropy (growth). Closed: Those unfriendly to new information; they tend to have a lot of entropy. Cybernetics: Norbert Weiner (1948) used this term to describe systems that self-regulate via feedback loops. Feedback loops: information pathways that help the system balance and correct itself. Can be negative (maintains the current bias and level of functioning) or positive (changes the bias/level of functioning). Double bind (Bateson, Jackson, Haley, Weakland): when the content and process of a message don't line up and you're not allowed to comment on that. No-talk rule: an unwritten family rule against members commenting on certain uncomfortable issues. Three kinds of therapeutic double-binds or paradoxes: prescribing, restraining ("don't change") , and positioning (exaggerate negative interpretations of the situation). Equifinality / Equipotentiality: Equifinality: things with dissimilar origins can wind up in similar places (e.g., an abuse survivor and someone from a healthy family can both grow up to be good parents). Equipotentiality: things with a common origin can go in very different directions of development (e.g., of two abuse survivors, one heals and the other becomes a criminal). First-order / Second-order change: First-order change: change that helps the system accommodate to its current level of functioning. Second-order change: a change that fundamentally impacts the system, thereby taking it to a new level of functioning. Pseudomutuality: Wynne, Lyman: noticed that many families exhibit pseudomutuality (fake togetherness). Punctuation: â&#x20AC;&#x153;The selective description of a transaction in accordance with a therapistâ&#x20AC;&#x2122;s goalsâ&#x20AC;?. Therefore, it is verbalizing appropriate behaviour when it happens. Rules: Expectations that govern the system on many levels. Can be covert or overt. Good rules maintain stability while allowing some adaptive changes; rigid ones block even modest attempts to adapt. A therapeutic task is to make the covert rules overt.

Basic Techniques in Family Counselling and Therapy The area of marriage and family counselling/therapy has exploded over the past decade. Counsellors at all levels are expected to work effectively with couples and families experiencing a wide variety of issues and problems. Structural, strategic, and transgenerational family therapists at times may seem to be operating alike, using similar interventions with a family. Differences might become clear when the therapist explains a certain technique or intervention. Most of today's practicing family therapists go far beyond the limited number of techniques usually associated with a single theory. Bowen therapists believe that understanding how a family system operates is far more important than using a particular technique. They tend to use interventions such as process questions, tracking sequences, teaching, coaching, and directives with a family. They value information about past relationships as a significant context from which they design interventions in the present. The following select techniques have been used in working with couples and families to stimulate change or gain greater information about the family system. Each technique should be judiciously applied and viewed as not a cure, but rather a method to help mobilize the family. The when, where, and how of each intervention always rests with the therapist's professional judgment and personal skills.

OBSERVATION Family units establish equilibriums to protect the family unit, but that equilibrium can cause an imbalance for individual parts of the family. A clinical psychologist is trained to observed the family dynamic and monitor both verbal and non-verbal cues. During the assessment phase and initial interviews, the family systems psychologist will monitor how the parents interact with each other and how their children react to them. He or she will compare his or her observations with testing data offered in both subjective and objective forms. The subjective test data is gathered during the interview while the objective test data is gathered via clinical tests that family members are requested to fill out and return to the psychologist. Observation is an effective family therapy technique because it offers the psychologist the first real window into the family dynamic. Family therapy may be recommended for any number of causes, but for the psychologist to make a fair and accurate assessment, he or she must get a base measurement of the family's interactions, emotional balance and initial dysfunction. During observation, for example, it may be revealed that a mother's depression and need for anti-anxiety medication is due in part to her husband's unemployment and the economic pressure she is overcompensating to fulfill. To create an effective treatment plan for the family, the therapist needs as much data as possible.

IDENTIFICATION Family therapy techniques are used with individuals and families to address the issues that effect the health of the family system. The techniques used will depend on what issues are causing the most problems for a family and on how well the family has learned to handle these issues. Strategic techniques are designed for specific purposes within the treatment process. Background information, family structuring and communication patterns are some of the areas addressed through these methods.

I/ INFORMATION-GATHERING TECHNIQUES At the start of therapy, information regarding the family's background and relationship dynamics is needed to identify potential issues and problems. GETTING INFORMATION THROUGH USING OPEN-ENDED QUESTIONS. An open-ended question cannot be answered with a simple "yes" or "no", or with a specific piece of information, and gives the person answering the question scope to give the information that seems to them to be appropriate. Open-ended questions are sometimes phrased as a statement which requires a response. Examples of open-ended questions: • • • • •

Tell me about your relationship with your husband. How do you see your future? Tell me about the children in this photograph. What is the purpose of this rule? Why did you choose that answer?

THE GENOGRAM Is an information gathering technique used to create a family history, or geneology. Both the family and therapist work to create this diagram. Bowen assumes that multigenerational patterns and influences are central in understanding present nuclear family functioning. A family genogram consists of a pictorial layout of each partner's three-generational extended family. It is a tool for both the therapist and family members to understand critical turning points in the family's emotional processes and to note dates of births, deaths, marriages, and divorces. The genogram also includes additional information about essential characteristics of a family: cultural and ethnic origins, religious affiliation, socioeconomic status, type of contact among family members, and proximity of family members. Names, dates of marriage, divorce, death, and other relevant facts are also included. Siblings are presented in genograms horizontally, oldest to youngest, each with more of a relationship to the parents than to one another. Bowen also integrates data related to birth order and family constellation. By providing an evolutionary picture of the nuclear family, a genogram becomes a tool for assessing each partner's degree of fusion to extended families and to each other. The genogram, a technique often used early in family therapy, provides a graphic picture of the family history. The genogram reveals the family's basic structure and demographics. As an informational and diagnostic tool, the genogram is developed by the therapist in conjunction with the family.

THE FAMILY FLOORPLAN By having family members draw up floor plans of their home, they provide information on territorial issues, rules, and comfort zones between different members. The family floor plan technique has several variations. Parents might be asked to draw the family floor plan for the family of origin. Information across generations is therefore gathered in a nonthreatening manner. Points of discussion bring out meaningful issues related to one's past. Another adaptation of this technique is to have members draw the floor plan for their nuclear family. The importance of space and territory is often inferred as a result of the family floor plan. Levels of comfort between family members, space accommodations, and rules are often revealed. Indications of differentiation, operating family triangles, and subsystems often become evident. Used early in therapy, this technique can serve as an excellent diagnostic tool (Coppersmith, 1980).

FAMILY PHOTOS Is an information gathering technique which has the potential to provide a wealth of information about past and present functioning and about how each member perceives the others. One use of family photos is to go through the family album together. Verbal and nonverbal responses to pictures and events are often quite revealing. Adaptations of this method include asking members to bring in significant family photos and discuss reasons for bringing them, and locating pictures that represent past generations. Through discussion of photos, the therapist often more clearly sees family relationships, rituals, structure, roles, and communication patterns.

II/ JOINING This is the process of coupling that occurs between the therapist and the family, leading to the development of therapeutic system. In this process the therapist allies with family members by expressing interest in understanding them as individuals and working with and for them. Joining is considered one of the most important prerequisites to restructuring. It is a contextual process that is continuous. There are four ways of joining in structural family therapy: tracking, mimesis, confirmation of a family member and accomodation. 1) TRACKING: The tracking technique is a recording process where the therapist keeps notes on how situations develop within the family system. Interventions used to address family problems can be designed based on the patterns uncovered by this technique. In tracking, the therapist follows the content of the family that is the facts. Tracking is best exemplified when the therapist gives a family feedback on what he or she has observed or heard. Most family therapists use tracking. Structural family therapists (Minuchin & Fishman, 1981) see tracking as an essential part of the therapist's joining process with the family. During the tracking process the therapist listens intently to family stories and carefully records events and their sequence. Through tracking, the family therapist is able to identify the sequence of events operating in a system to keep it the way it is. What happens between point A and point B or C to create D can be helpful when designing interventions. 2) MIMESIS: The therapist becomes like the family in the manner or content of their communications. 3) CONFIRMATION OF A FAMILY MEMBER: Using an affective word to reflect an expressed or unexpressed feeling of that family member. 4) ACCOMMODATION: The therapist adapts to a family's communication style. He makes personal adjustments in order to achieve a therapeutic alliance.

III/ DIAGNOSING Diagnosing is done early in the therapeutic process. The goal is to describe the systematic interrelationships of all family members to see what needs to be changed or modified for the family to improve. By diagnosing interactions, therapists become proactive, instead of reactive.

IV/ FAMILY SYSTEM STRATEGIES A family operates like a system in that each member's role contributes to the patterns of behaviour that make the system what it is. Certain therapy techniques are designed to reveal the patterns that make a family function the way it does. ASKING PROCESS QUESTIONS. The most common Bowen technique consists of asking process questions that are designed to get clients to think about the role they play in relating with members of their family. Bowen's style tended to be controlled, somewhat detached, and cerebral. In working with a couple, for example, he expected each partner to talk to him rather than to talk directly to each other in the session. His calm style of questioning was aimed at helping each partner think about particular issues that are problematic with their family of origin. One goal is to resolve the fusion that may exist between the partners and to maximize each person's self-differentiation both from the family of origin and the nuclear family system. A Bowen therapist is more concerned with managing his or her own neutrality than with having the "right" question at the right time. Still, questions that emphasize personal choice are very important. They calm emotional response and invite a rational consideration of alternatives. A therapist attempting to help a woman who has been divorced by her husband may ask: •

"Do you want to continue to react to him in ways that keep the conflict going, or would you rather feel more in charge of your life?"

•

"What other ways could you consider responding if the present way isn't very satisfying to you and is not changing him?"

•

"Given what has happened recently, how do you want to react when you're with your children and the subject of their father comes up?"

Notice that these process questions are asked of the person as part of a relational unit. This type of questioning is called circular, or is said to have circularity, because the focus of change is in relation to others who are recognized as having an effect on the person's functioning. FAMILY SCULPTING Family sculpting is a technique that's used to realign relationship patterns within the group. Members are asked to physically arrange where they want each member to be in relation to the others. This technique provides insight into relationship conflicts within the family. Family sculpting provides for recreation of the family system, representing family members relationships to one another at a specific period of time. The family therapist can use sculpting at any time in therapy by asking family members to physically arrange the family. Adolescents often make good family sculptors as they are provided with a chance to nonverbally communicate thoughts and feelings about the family. Family sculpting is a sound diagnostic tool and provides the opportunity for future therapeutic interventions. FAMILY CHOREOGRAPHY In family choreography, arrangements go beyond initial sculpting; family members are asked to position themselves as to how they see the family and then to show how they would like the family situation to be. Family members may be asked to reenact a family scene and possibly resculpt it to a preferred scenario. This technique can help a stuck family and create a lively situation.

V/ Intervention Techniques Intervention techniques are directives given by the therapist to guide a family's interactions towards more productive outcomes. Reframing is a method used to recast a particular conflict or situation in a less threatening light. A father who constantly pressures his son regarding his grades may be seen as a threatening figure by the son. Reframing this conflict would involve focusing on the father's concern for his son's future and helping the son to "hear" his father's concern instead of constant demands for improvement. Another technique has the therapist placing a particular conflict or situation under the family's control. What this means is, instead of a problem controlling how the family acts, the family controls how the problem is handled. This requires the therapist to give specific directives as to how long members are to discuss the problem, who they discuss it with, and how long these discussions should last. As members carry out these directives, they begin to develop a sense of control over the problem, which helps them to better deal with it effectively. RELATIONSHIP EXPERIMENTS. “Relationship experiments are behavioural tasks assigned to family members by the therapist to first expose and then alter the dysfunctional relationship process in the family system” (Guerin, 2002, p. 140). Most often, these experiments are assigned as homework, and they are commonly designed to reverse pursuerdistancer relationships and/or address the issues related to triangulation. Detriangulation. Relationship experiments are incorporated within Guerin’s five-step process for neutralization of symptomatic triangles in which he (1) identifies the triangle, (2) delineates the triangle’s structure and movement, (3) reverses the direction of the movement, (4) exposes the emotional process, and (5) addresses the emotional process to augment family functionality. COACHING. Bowen used coaching with well-motivated family members who had achieved a reasonable degree of selfdifferentiation. To coach is to help people identify triggers to emotional reactivity, look for alternative responses, and anticipate desired outcomes. Coaching is supportive, but is not a rubber-stamp: It seeks to build individual independence, encouraging confidence, courage, and emotional skill in the person. I-POSITIONS. I-positions are clear and concise statements of personal opinion and belief that are offered without emotional reactivity. When stress, tension, and emotional reactions increase, I-positions help individual family members to step-back from the experience and communicate from a more centred, rational, and stabilized position. Bowen therapists model I-positions within sessions when family members become emotionally reactive, and as family members are able to take charge of their emotions, Bowen therapists also coach them in the use of I-statements. DISPLACEMENT STORIES. Displacement stories are usually implemented through the use of film or videotape, although storytelling and fantasized solutions have also been used. The function of a displacement story is to provide a family or family members with an external stimulus (film, video, book or story) that relates to the emotional process and triangulation present in the family, but allows them to be considered in a less defensive or reactive manner. Films, like “I Never Sang For My Father,” “Ordinary People,” or “Avalon” have all been used by Bowen therapists to highlight family interactions and consequences and to suggest resolutions of a more functional nature.

TAKING SIDE & MEDIATING. In contrast to Bowen's belief in the importance of neutrality, another influential family therapist, Zuk (1981) discusses practical applications of working with triangles in family therapy. Zuk terms his triadic-based technique go-between process because it relies on the therapists "taking and trading roles... of the mediator and side-taker". The mediator is one person mediating between at least two others. The side-taker joins one person in coalition against another. Zuk (1981) outlines three steps involved in the go-between process (p. 38). • • •

In step 1, the therapist works on initiating conflict. In step 2, the therapists moves into the role of the go-between. In step 3, the therapist assumes the role of side-taker.

In all three steps it is important to keep the interactions focused on the present. Past events preclude the therapist's involvement in mediating or side-taking. Because triangles constantly move around, the current permutation might be different from the past. The goal of the therapist is to change the pathogenic relating around into a more productive way of relating. THE EMPTY CHAIR The empty chair technique, most often utilized by Gestalt therapists (Perls, Hefferline, & Goodman, 1985), has been adapted to family therapy. In one scenario, a partner may express his or her feelings to a spouse (empty chair), then play the role of the spouse and carry on a dialogue. Expressions to absent family, parents, and children can be arranged through utilizing this technique. FAMILY COUNCIL MEETINGS Family council meetings are organized to provide specific times for the family to meet and share with one another. The therapist might prescribe council meetings as homework, in which case a time is set and rules are outlined. The council should encompass the entire family, and any absent members would have to abide by decisions. The agenda may include any concerns of the family. Attacking others during this time is not acceptable. Family council meetings help provide structure for the family, encourage full family participation, and facilitate communication. STRATEGIC ALLIANCES This technique, often used by strategic family therapists, involves meeting with one member of the family as a supportive means of helping that person change. Individual change is expected to affect the entire family system. The individual is often asked to behave or respond in a different manner. This technique attempts to disrupt a circular system or behaviour pattern. PRESCRIBING INDECISION The stress level of couples and families often is exacerbated by a faulty decision-making process. Decisions not made in these cases become problematic in themselves. When straightforward interventions fail, paradoxical interventions often can produce change or relieve symptoms of stress. Such is the case with prescribing indecision. The indecisive behaviour is reframed as an example of caring or taking appropriate time on important matters affecting the family. A directive is given to not rush into anything or make hasty decisions. The couple is to follow this directive to the letter. PUTTING THE CLIENT IN CONTROL OF THE SYMPTOM This technique, widely used by strategic family therapists, attempts to place control in the hands of the individual or system. The therapist may recommend, for example, the continuation of a symptom such as anxiety or worry. Specific directives are given as to when, where, and with whom, and for what amount of time one should do these things. As the client follows this paradoxical directive, a sense of control over the symptom often develops, resulting in subsequent change.

SPECIAL DAYS, MINI-VACATIONS, SPECIAL OUTINGS Couples and families that are stuck frequently exhibit predictable behaviour cycles. Boredom is present, and family members take little time with each other. In such cases, family members feel unappreciated and taken for granted. "Caring Days" can be set aside when couples are asked to show caring for each other. Specific times for caring can be arranged with certain actions in mind (Stuart, 1980). PROBLEM SOLVING Problem solving is an effective therapy technique not because it teaches the family how to resolve the issue that brought them to see the family systems psychologist, but it teaches them how to identify, develop plans and create resolutions for future problems. Problem solving may seem like a common sense resolution, but it requires a willingness on the parts of all parties to contribute to the solution. Problem solving is a family therapy technique that requires effective communication and often comes later in therapy sessions as the therapist challenges family members to role-play situations previously deemed irresolvable. Family members may also be required to play the part of other family members, parents playing the part of the children or dad taking on the role of mom to a child's dad and a mom's child. By actively role playing other members of the family, each member is required to see that person's point of view. This leads to learning how to disagree in positive and respectful manner and to not allow those disagreements to impede problem solving efforts. FAMILY CONTRACTS The family contract is a therapeutic tool that allows families to negotiate terms and come to an agreement on how they want to handle future family problems and to commit to positive change. A family contract, for example, may detail that a child who copes with an eating disorder commits to talking about her feelings on weight, eating and social perception. Her parents will then commit to listening and not dismissing her feelings. All parties commit to working together to build self-esteem and a healthy lifestyle. Family contracts are a positive tool in the arsenal of a family systems psychologist because they are facilitated agreement that a family makes to avoid future dysfunction. The family contract also helps family members recognize when problems are occurring, particularly if elements of the contract are not being upheld. Effective family therapy techniques treat the entire family as an emotional unit of which each family member is a part of and acknowledges that what affects one member of the family affects the whole family. By treating the whole family as a unit, the family also becomes a part of the solution. REFRAMING Technique used to create a different perception of reality. Reframing is a process in which a perception is changed by explaining a situation in terms of a different context. For example, the therapist can reframe a disruptive behaviour as being naughty instead of incorrigible allowing family members to modify their attitudes toward the individual and even help him or her makes changes. Most family therapists use reframing as a method to both join with the family and offer a different perspective on presenting problems. Specifically, reframing involves taking something out of its logical class and placing it in another category (Sherman & Fredman, 1986). For example, a mother's repeated questioning of her daughter's behaviour after a date can be seen as genuine caring and concern rather than that of a nontrusting parent. Through reframing, a negative often can be reframed into a positive. Reframing is altering the meaning or value of something, by altering its context or description Reframing is a powerful change stratagem. It changes our perceptions, and this may then affect our actions. But does changing our symbolic representation of the real world actually change anything in the real world itself? Kolb describes the four basic creative dimensions as Meaning, Value, Relevance and Fact. This is summarized in the diagram above. In these terms, reframing is altering Meaning, Value, Relevance or Fact by altering context or perspective.

Bandler & Grinder (NLP) identify two forms of reframing: meaning and context. Context reframing takes an undesired attribute and finds a different situation where it would be valuable. In meaning reframing, you take an undesired attribute and find a description where the attribute takes on a positive value. Reframing - Virginia Satir A classic example of a reframe by Virginia Satir concerns a father who complains at the stubbornness of his daughter. This results in a double reframe, in which Satir points out two things to the father: 1. There are situations where she will need stubbornness, to protect herself or achieve something. Reframing switches to a context that makes the stubbornness relevant. 2. It is from the father himself that she has learned to be stubborn. By forcing the father to equate his own stubbornness with hers, this creates a context in which he either has to recognize the value of her stubbornness, or deny the value of his own. Reframing - Milton Erikson One of the common challenges of family therapy is to help the parents to let their children go. Independence is of course a negative goal. The parents have to gradually stop supporting their children, and the children have to gradually stop relying on their parents. Milton Erikson often used the approach of creating an alternative goal for the parents: of preparing themselves to be grandparents. In a typical case, a young woman consulted him; her parents had used their life savings to build an extension to their house, where she was to live, when she got married (At this time, she was away at college, and had no steady boyfriend.) Erikson met the parents, and congratulated them for their willingness to participate so actively in the rearing of their (hypothetical) grandchildren, having babies crying through the night, toddlers crawling through the living rooms, toys strewn across the house, babysitting. He thus created a powerful positive image of the joys of grandparenthood; yet for some reason, the couple decided to rent the extra rooms out to mature lodgers instead, and save the money to support their grandchildren’s education. When the daughter subsequently got married, she lived in a city some distance away with husband and baby, and the grandparents visited frequently, but not too frequently. http://www.blackwellreference.com/public/tocnode?id=g9780631170488_chunk_g97806311 7048821_ss1-9 PUNCTUATION Technique used to create a different perception of reality. Punctuation is “the selective description of a transaction in accordance with a therapist’s goals”. Therefore it is verbalizing appropriate behaviour when it happens. UNBALANCING Technique used to create a different perception of reality. This is a procedure wherein the therapist supports an individual or subsystem against the rest of the family. When this technique is used to support an underdog in the family system, a chance for change within the total hierarchical relationship is fostered.

RESTRUCTURING Technique used to create a different sequence of events. The procedure of restructuring is at the heart of the structural approach. The goal is to make the family more functional by altering the existing hierarchy and interaction patterns so that problems are not maintained. It is accomplished through the use of enactment, unbalancing, and boundary formation. ENACTMENT Technique used to create a different sequence of events. The process of enactment consists of families bringing problematic behavioural sequences into treatment by showing them to the therapist a demonstrative transaction. This method is to help family members to gain control over behaviours they insist are beyond their control. The result is that family members experience their own transactions with heightened awareness. In examining their roles, members often adapt new, more functional ways of acting. BOUNDARY FORMATION Technique used to create a different sequence of events. Part of the therapeutic task is to help the family define, or change the boundaries within the family. The therapist also helps the family to either strengthen or loosen boundaries, depending upon the familyâ&#x20AC;&#x2122;s situation. WORKING WITH SPONTANEOUS INTERACTION In addition to enactment, structural family therapists concentrate on spontaneous behaviours in sessions. It occurs whenever families display behaviours in sessions that are disruptive or dysfunctional, such as members yelling at one another or parents withdrawing from their children. The focus is on process not content. It is important that therapists help families recognize patterns of interaction and what changes they might make to bring about modification. INTENSITY Intensity is the structural method of changing maladaptive transactions by using strong affect, repeated intervention, or prolonged pressure. Intensity works best if done in a direct, unapologetic manner that is goal specific. SHAPING COMPETENCE The family therapists help families and individuals in becoming more functional by highlighting positive behaviours. ADDING COGNITIVE CONSTRUCTIONS Advice & Information are derived from experience and knowledge of the family in therapy. They are used to calm down anxious members of families or reassure these individuals and families about certain actions. Pragmatic fictions are formal expressions of opinion to help families and their members change. Paradox is an apparently sound argument leading to a contradiction. It is used to motivate family members to search or alternatives. Family members may defy the therapists and become better or they may explore reasons why their behaviours are as they are and make changes in the ways members interact. Also used to tell the family what to do with the expectation of noncompliance.

VI/ COMMUNICATION SKILL BUILDING TECHNIQUES More often than not, it's a family's communication patterns and styles that lead to conflict and division. Communication techniques are used to build skills that allow for effective communication between family members. Some of these methods include reflecting, repeating, fair fighting and nonjudgmental brainstorming. REFLECTING Reflecting is a listening technique which involves having a member express her feelings and concerns, then having another member repeat back what he heard that person say. REPEATING Repeating is also a listening technique. It involves having a member state how he feels, while another member repeats back what was said. Repeating and reflecting techniques allow members to better understand where the other is coming from and why she feels as she does. FAIR FIGHTING Fair fighting techniques focus on attentive listening and expressing feelings and concerns in a nonthreatening manner. TAKING TURNS EXPRESSING FEELINGS taking turns expressing feelings NONJUDGMENTAL BRAINSTORMING nonjudgmental brainstorming If each member of the family is interdependent on other members of the family it stands to reason that dysfunction with one will affect the whole. Effective communication is an important lesson that family systems psychologist incorporate into group and individual family therapy sessions. To create an effective solution to any dysfunction or problem in the group dynamic requires effective communication so that all members of the group or family are in touch with each other. For example, the mother who commits to more and more tasks in order to compensate for her family's overextending commitments may stretch herself to the limits because she lacks the ability to communicate how stretched thin she is. Instead, she promises to do more and more, exerting increasing emotional and mental stress upon herself when she cannot meet all the commitments she is making. This leads to disappointment and disagreement in the family. When other members of the family express their disappointment, this impacts her already damaged sense of self-worth leading to a vicious cycle that may result in depression, generalized anxiety disorder, substance abuse and more. In every way, however, the family is not happy. Therapists teach effective communication skills and the importance for mom to let the family know she is overextended and that she either needs help or they need to rearrange priorities in order to break out of the circular causality of this family's problems. Effective communication allows a family to dialogue on their problems, concerns and feelings without lashing out or feeling obligated to resolve the problems being shared. A large portion of effective communication resides in active listening, a skill that must be learned. Communication patterns and processes are often major factors in preventing healthy family functioning. Faulty communication methods and systems are readily observed within one or two family sessions. The family therapist constantly looks for faulty communication patterns that can disrupt the system.

Structure of a Family Therapy Session By an eHow Contributor Family communication is an evolving and complicated issue for most families. Sometimes a family therapy session is the only place where each family member can have a voice. As children grow and marriages evolve, the lack of communication within a family may cause issues, anger and sadness in some family members. Family therapy sessions help with issues like divorce, financial problems, grief, depression, stress and substance abuse. As a counselor, you will need to have all voices heard to find out what issues or problems each of the family members bring to the family dynamic.

Instructions 1.

Research and Background

1 Ask the family member who initiated the family session why he feels the family needs the therapy.This will give you his perspective on the situation and on what is happening to the family.

2 Find out which family members are involved, and invite them to the sessions. Let each family member know that the therapy will not be effective if anyone misses a session. It is best to reschedule if one family member cannot make it to a session.

3 Conduct an individual and private session with each family member before commencing the family session.

4 Ask all family members why they think they need a family session. Inquire if they have any issues with the family or any individual members of the family.

5 Take notes on each session. Make sure you write down each family member's thoughts and concerns for future reference.

6 Recommend individual counseling for those members who have problems stemming from trauma or childhood problems. They will continue to bring their issues to the family dynamic, so it is critical to resolve their issues to help the family unite.

Family Session

1 Review your notes from each session you had with individual family members. This will refresh your memory and let you understand more background information before you conduct your family session.

2 Set rules for the family therapy session. Ask members to contribute to how the session will be conducted. Some members may insist on having one person at a time speak, or perhaps there may be a time limit set for each person. Let each person contribute.

3 Begin by asking each member what kind of family dynamic they prefer. You can ask them if they prefer a family that is close, laughs a great deal and takes fun-filled family vacations without drama.

4 Ensure that each member is allowed to speak without interruption. You will be acting as a mediator on how the session is conducted. You will also be enforcing the rules the family has set in advance.

5 Start to resolve each individual issue that the family has brought up. Give each family member an opportunity to provide a solution.

6 Apply values and standards to the solutions to the family issue that fit within that family's value system. Devise a followup to find how the solutions are working, and invite individual family members to contact you to ask questions.

7 Meet with individual family members to see if the resolution is what they expected. Inquire if they feel problems are resolving. Some issues may be based from family disputes; others may stem from trauma or childhood problems.

Read more: How to Conduct a Family Therapy Session | eHow.com http://www.ehow.com/how_4912419_conduct-family-therapy-session.html#ixzz1J7TX2G6W

Stages and Steps of Problem-Centred Systems Therapy Assessment

Contracting

Treatment

Closure

Orientation Data gathering Problem descriptions Clarification and agreement on a problem list

Orientation Outlining options Negotiating expectations Contract signing

Orientation Clarifying priorities Setting tasks Task evaluation

Orientation Summary of treatment Longterm goals Follow up (optional)

A Guideline for Family Assessment Areas Covered

1. Orientation Their expectations Our expectations Rationale for seeing the family

2. Data Gathering a. Presenting

Problem (for each problem) Nature and history of problem Affective/emotion al components Precipitating events Who is involved and how

3. Problem List Family's list Doctor adds his

4. Problem Clarification Obtain agreement on list from above

b. General Family Functioning: McMaster model dimensions Problem solving Roles Communication Affective involvement Affective responsiveness Behavior control c. Other

Investigationsbiop sychosocial: medical d. Any other problems?

Summary of Dimension Concepts Problem-solving Two types of problems instrumental and affective

Seven stages to the process 1. Identification of the problem 2. Communication of the problem to the appropriate person(s) 3. Development of action alternatives 4. Decision of one alternative 5. Action 6. Monitoring the action 7. Evaluation of success

Postulated Most effective when all seven stages are carried out. Least effective when cannot identify problem (stop before step 1)

Communication Instrumental and affective areas Two independent dimensions 1. Clear and Direct 2. Clear and Indirect 3. Masked and Direct 4. Masked and Indirect

Postulated Most effective: clear and direct. - Least effective: masked and indirect

Roles Two family function types -necessary and other Two areas of family functions -instrumental and affective Necessary family function groupings A. Instrumental 1. Provision of Resources

B. Affective 1. Nurturance and Support 2. Adult Sexual Gratification C. Mixed 1. Life Skills Development 2. Systems Maintenance and management Other family functions: -adaptive and maladaptive Role functioning is assessed by considering how the family allocates responsibilities and handles accountability for them.

Affective Involvement Six styles identified 1. Absence of involvement 2. Involvement devoid of feelings 3. Narcissistic involvement 4. Empathic involvement 5. Over-involvement 6. Symbiotic involvement

Postulated Most effective: empathic involvement. - Least effective: -symbiotic and absence of involvement

Postulated Most effective when all necessary family functions have clear allocation to reasonable individuals(s), and accountability built in. Least effective when necessary family functions are not addressed and/or allocation and accountability not maintained.

Affective Responsiveness Two groupings -welfare emotions and emergency emotions Postulated Most effective when full range of responses are appropriate in amount and quality to stimulus. - Least effective when very narrow range (one or two affects only) and/or amount and quality is distorted, given the context

Behavior Control Applies to three situations 1. Dangerous situations 2. Meeting and expressing psychobiological needs and drives (eating, drinking, sleeping, eliminating, sex and aggression) 3. Interpersonal socializing behaviour inside and outside the family Standard and latitude of acceptable behavior determined by four styles 1. Rigid 2. Flexible 3. Laissez-faire 4. Chaotic To maintain the style, various techniques are used and implemented under role functions (systems maintenance and management)

Postulated Most effective: flexible behavior control. Least effective: chaotic behaviour control

Structure of Family Therapy —Outline by Patty Salehpur A. Assumptions 1. Family are individuals who effect each other in powerful but unpredicatable ways 2. The consistent repetitive organized and predictable patterns of family behavior are important 3. The emotional boundaries and coalitions are important B. Salvador Minuchin 1. Always concerned with social issues 2. Developed a theory of family structure and guidelines to organize therapeutic techniques 3. 1970 headed Philadelphia Child Guidance Clinic where family therapists have been trained in structural family therapy ever since 4. Born in Argentina , served in the Israel army as a physician, in the USA trained in child psychiatry and psychoanalysis with Nathan Ackerman, worked in Israel with displaced children, also worked in the USA with Don Jackson with middle class families. 5. Fist generation of family structural therapists: Braulio Montalvo, Jay Haley, Bernie Rosman, Harry Aponte, Carter Umbarger, Marianne Fishman, Cloe Madanes, and Stephen Greenstein. C. Theoretical formulations - three essential constructs 1. Structure — the organized pattern in which family members interact, predictable sequences of family interaction, patterns of interaction. Structure involves a series of covert rules. There are universal and idiosyncratic constraints. Families may not be able to tell you the family structure, but they will show it to you in their interactions. 2. Subsystems — Families are differentiated into subsystems of members who join together to perform various functions. Each person is a member of one or more subsystems in the family. Some groupings are obvious and based on such factors as generation, gender, age or common interests. Other coalitions may be subtle. Every member may play many roles in various subgroups. 3. Boundaries are invisible barriers that regulate the amount and nature of contact with members. They range from rigid to diffuse, clear to unclear, disengaged to enmeshed D. Normal family development 1. Marriage begins with accommodation and boundary making 2. Couples are influenced by the structure of their families of origin 3. Couples also form boundaries with their families of origin 4. The advent of children requires that the structure of the family change 100

E. The development of behavior disorders 1. Family dysfunction results from stress and failure to realign the structure to cope with it. 2. Disengaged families have rigid boundaries and excessive emotional distance. They fail to mobilize to deal with the stress. 3. Enmeshed families have diffuse boundaries and family members overreact emotionally and become intrusively involved with one another. These actions hinder mature actions to resolve stress. 4. Subsystems in the family may be disengaged or enmeshed. 5. Power hierarchies may develop which may be weak and ineffective or rigid and arbitrary. 6. Conflict avoidance prevents effective problem solving. 7. Generational coalitions may also prevent effective problem solving. 8. Family structure may fail to adjust to family developmental processes. 9. A major change in family composition demands structural adaptation. 10. Symptoms in one family member may reflect dysfunctional structural relationships or simply individual problems. F. Goals of therapy 1. Changing family structure - altering boundaries and realigning subsystems 2. Symptomatic change - growth of the individual while preserving the mutual support of the family 3. Short-range goals may be developed to alleviate symptoms especially in life threatening disorders such as anorexia nervosa, but for long-lasting effective functioning the structure must change. Behavioral techniques fit into these short-term strategies. G. Techniques â&#x20AC;&#x201D; join, map, transform structure 1. Joining and accommodating, then taking a position of leadership a. Listen to "I" statements 2. Enactment for understanding and change 3. Working with interaction and mapping the underlying structure a. Looking at the power hierarchies b. Using enactment to understand and clarify c. Looking at the boundary structures 4. Diagnosing a. individual vs. subgroup b. structural diagnosis 101

5. Highlighting and modifying interpersonal interactions is essential a. Control intensity by the regulation of affect, repetition and duration b. Don’t dilute the intensity through overqualifying, apologizing or rambling c. Shape competence, e.g. "It’s too noisy in here. Would you quiet the kids." 6. Boundary making and boundary strengthening a. Seating b. Seeing subgroups or individuals to foster boundaries and indivduation c. Clarify circular causation 7. Unbalancing may be necessary a. Taking sides b. Challenging c. Directives 8. Challenging the family’s assumptions may be necessary a. Teaching may be necessary b. Pragmatic fictions c. Paradoxes d. Therapist sometimes must challenge the way family members perceive reality, changing the way family member relate to each other offers alternative views of reality. 9. Therapists must create techniques to fit each unique family

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Systemic Family Therapy Manual

Ms. Helen Pote Dr. Peter Stratton Prof. David Cottrell Ms. Paula Boston Prof. David Shapiro Ms Helga Hanks

Leeds Family Therapy & Research Centre School of Psychology University of Leeds Leeds, LS2 9JT

This manual was developed through an MRC Small Project Grant, Number G9700249 ďŁŠ No part of this document should be reprinted without the permission of the authors.

103

Table of Contents 1. Introduction

1.1 Origins of the Manual

1.2 Aims and applicability of the manual

1.3 Notes on use of manual 1.4 Ethical and Culturally Sensitive Practice 1.5 Clinical Examples

7 8 8

2. Guiding Principles

2.1 Systems Focus

2.2 Circularity

2.3 Connections and Patterns

2.4 Narratives and Language

2.5 Constructivism

2.6 Social Constructionism

2.7 Cultural Context

2.8 Power

2.9 Co-constructed therapy

2.10 Self-Reflexivity

2.11 Strengths and Solutions

3. Outline of Therapeutic Change

3.1 Models of Therapeutic Change 3.2 Overview of Specific Goals

4. Outline of Therapist Interventions

12 13

4.1 Linear Questioning

4.2 Circular Questions 4.3 Statements 4.4 Reflecting Teams 4.5 Child Centred Interventions

14 15 16 18

104

5. Therapeutic Setting

5.1 Convening Sessions

5.2 Team

5.3 Video

5.4 Pre-therapy Preparation

5.5 Pre and Post Session Preparation

5.6 Correspondence

5.7 Case Notes

5.8 Session Notes

6. Initial sessions 6.1 Outline Therapy Boundaries & Structure 6.2 Engage and Involve all family members 6.3 Gather and Clarify Information 6.4 Establish Goals and Objectives of Therapy 4 Initial Session Checklist for Therapists

7. Middle sessions 7.1 Develop engagement 7.2 Gather Information and Focus Discussion 7.3 Identify & Explore Beliefs 7.4 Work towards change at the level of behaviours and beliefs 7.5 Return to Objectives and Goals of Therapy 4 Middle Sessions Checklist for Therapists

8. End sessions 8.1 Gather Information and Focus Discussion 8.2 Continue to work towards change at the level of behaviours and beliefs 8.3 Develop family understanding about behaviours and beliefs 8.4 Collaborative ending decisions 8.5 Review the process of therapy 4 End Session Checklist for Therapists

23 23 24 25 25 26

27 27 27 28 30 37 38

39 39 40 41 41 42 42

105

9. Indirect Work 9.1 Child Protection 9.2 Clarifying therapy with referrer present 9.3 Identifying network and clarifying relationships 9.4 Assessing risk 9.5 Correspondence

10. Proscribed Practices 10.1 10.2 10.3 10.4 10.5 10.6 10.7 10.8 10.9 10.10 10.11 10.12 10.13 10.14 10.15 10.16

Advice Interpretation Un-transparent/Closed Practice Therapist monologues Consistently siding with one person Working in the transference Inattention to use of language Reflections Polarised position Sticking in one time frame Agreeing / not challenging ideas Ignoring information that contradicts hypothesis Dismissing ideas Inappropriate affect Ignoring family affect Ignoring difference

43 43 43 43 44 44

45 45 45 45 45 45 46 46 46 46 46 46 46 47 47 47 47

106

Appendices Appendix 1: Sample Appointment Letter

Appendix II: Sample Video Consent Form

Appendix III: Sample Referrer letter

Appendix IV: Post-assessment letter to referrer

Appendix V: Closing letter to referrer

Figures Figure 1: Models of Therapeutic Change

Tables Table 1: Perceptions that are helpful in achieving change

107

1. Introduction 1.1 Origins of the Manual The manual was developed through a research project funded by the Medical Research Council. The team developing the manual comprised of a group of experienced family therapists working at Leeds Family Therapy & Research Centre (LFTRC). LFTRC is a centre working systemically with individuals, couples and families across the age span, as well as with professional systems. The therapists contributing to this manual have historically been influenced by Milan Systemic family therapy models, and would now describe their practice as being influenced by Post-Milan and Narrative Models.

1.2 Aims and applicability of the manual The manual is principally designed as a research tool for outcome studies in which the effectiveness of systemic therapy can be assessed. It therefore aims to offer a framework and guidelines for the implementation of systemic family therapy, so that therapists can offer a unified version of therapy, with some flexibility to express their own creativity. For this purpose the manual should be used in conjunction with the accompanying adherence protocol. This is designed to assess the degree to which therapists are able to adhere to the methods outlined throughout the manual. For research purposes the manual is designed for use by trained family therapists or other trained therapists with experience in family therapy. The manual’s function is to guide therapeutic work with families in a clinic setting. Therapists using the manual will be expected to be working as part of a systemic family therapy team. Details on the composition of therapy teams are outlined later. υ Section 5.2 The manual can also be used less formally as a framework for training and supervision, in developing skills for trainee family therapists.

1.3 Notes on use of manual As with any interpersonally focused therapy, systemic family therapy does not follow a rigidly prescribed treatment sequence (Lambert & Ogles 1988). In using the manual therapists should consider the following guidelines: •

Therapists should first become familiar with the guiding principles which will influence all aspects of the therapy that they carry out using this manual. They should consider the guiding principles which are influencing them currently and the connections they make between these principles. υ Section 2.

•

They should then consider the section concerning models of change, and consider the model of change that is influencing their own therapeutic practice. υ Section 3.

•

After these more theoretical aspects have been addressed, the therapist should begin to consider the general interventions used, thinking carefully about the descriptions of these interventions, and how they may translate into their own practice. υSection 4.

•

The manual then turns to guidelines for convening sessions, and setting up the therapy itself. 108

Therapists should therefore begin to follow the guidelines of the manual from the moment they take referrals, in order to consider systemic issues in convening therapy. υ Section 5. •

Therapists should then use the manual to more specifically guide therapy sessions, reading the practical guidelines outlined for the beginning middle and end of therapy, and following the goals defined for each of these stages. Therapists’ checklists are provided at the end of each of these sections to help therapists consider whether they have covered all aspects of the guidelines. υ Sections 6, 7, & 8.

•

Therapists should go on to consider the aspects of indirect work that support the family therapy which should still be managed following the systemic guiding principles. υ Section 9. Finally, therapists should consider the proscribed practices which should not form a significant proportion of their work, and refer back to these during the course of therapy to ensure proscribed practices do not emerge during the course of therapy. υ Section 10.

•

This manual has an accompanying questionnaire for therapists and an adherence protocol to assess the degree to which therapist practice reflects that of the manual. This may be used as a personal check for therapists or trainers using the manual, or more formally by an independent researcher to assess adherence when the manual is being used as a research tool.

1.4 Ethical & Culturally Sensitive Practice In using this manual therapists should pay keen attention to ensuring their practice is both ethical and culturally sensitive. Their practice should comply with the Association for Family Therapy and Systemic Practice (AFT): Code of Conduct and Ethical Guidelines. Therapists should remain curious and open minded in working with families, and this may be especially important where the individuals/families are of a different gender, cultural or societal background to that of the therapist. Care should be taken in the assumptions and agendas therapists develop during therapy in this regard.

1.5 Clinical Examples All of the clinical material used in this manual has been adapted from extracts of therapy undertaken at Leeds Family Therapy & Research Centre. Identifying details have been removed from the material, and the dialogue modified to protect confidentiality. We would like to thank all of the families and therapists who have given permission for the therapy they undertook to be used for research. Without this permission the research project to develop this manual would not have been possible.

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2. Guiding Principles These principles are based at the level of theory, and should be used to guide therapistsâ&#x20AC;&#x2122; practice whilst using this manual in work with families. Therapists should be familiar with all of the principles though they may privilege different principles according to their current interests and the needs of the family with which they are working. The therapist should consider the principles flexibly and decide which might best fit with the issues with which the family are struggling and the therapists own current constructions. The principle of self-reflexivity may be particular helpful in enabling the therapist to reach this. Ď&#x2026;Section 2.10 In devising this manual therapists considered their own constructions of how these principles might connect. Therapists should consider for themselves the connections they are currently making between these principles and the effect this may have on their work with families.

2.1 Systems Focus In working systemically the central focus should be upon the system rather than the individual, particularly in relation to the difficulties and issues that the family system brings to therapy. The system may be A consistent view is that these difficulties do not arise within individuals but in the relationships, interactions and language that develop between individuals.

2.2 Circularity Patterns of behaviour develop within systems, which are repetitive and circular in nature and also constantly evolving. Behaviour and beliefs that are perceived as difficulties will also therefore develop in a circular fashion, being affected by and affecting all members of the system.

2.3 Connections and Patterns In understanding relationships and difficulties within systems it will be important for the therapist to consider the connections between circular patterns of behaviour, and the connections between the beliefs and behaviours within systems. The process of therapy should enable family members to consider these connections from new and/or different perspectives.

2.4 Narratives and Language Behaviours and beliefs form the basis of stories or narratives, which are constructed by, around, and between individuals and the system itself. The language that is used to describe these narratives and the interactions between individuals constructs the reality of their everyday lives. The stories that people live often match the stories that are told about individuals, but at times when stories lived and stories told are incongruous change may occur, at the levels of lived behaviours and/or the construction of new narratives.

2.5 Constructivism This is the idea that people form autonomous meaning systems and will interpret and make sense of information from this frame of reference. In social interactions understanding is constrained and affected by this meaning system, and people cannot make assumptions about what meaning will be attributed to the information they offer/contribute to others. Thus there is only the possibility of perturbing other peopleâ&#x20AC;&#x2122;s meaning systems.

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2.6 Social Constructionism In working with systems in the process of change at the level of behaviour or narratives, it will be important to consider ideas of social constructionism. Relevant is the idea that meaning is created in the social interactions that take place between people and is thus context dependent and constantly changing, this takes precedence over the concept of a single external reality.

2.7 Cultural Context The therapist should consider the importance of context, in relation to the cultural meanings and narratives within which people live their lives, including issues of race, gender, disability and class etc. The relationship between these narratives, the therapeutic relationship and its context, as well as the wider context for the therapeutic team and the family should be an important consideration at the point of referral and throughout the therapy.

2.8 Power The therapist should take a reflexive stance in relation to the power differentials that exist within the therapeutic relationship, and within the family relationships.

2.9 Co-constructed therapy In therapeutic interactions reality is co-constructed between the therapist (and team) and the people with whom they meet. They form part of the same system, and share responsibility for change and the process of therapy. Particular attention should thus be paid to the contributions that all members of the therapeutic system make in the process of change.

2.10 Self-Reflexivity The therapist should aim to apply systemic thinking to themselves and thus reject any thinking about families and their processes that does not also apply to therapists and therapy. Selfreflexivity focuses especially on the effect of the therapy process on the therapist and the way that this is a source of (resource for) change in the family. In order to use self-reflexivity it will be necessary for the therapist to be alert to their own constructions, functioning and prejudices so that they can use their self effectively with the family.

2.11 Strengths and Solutions The therapist should take a non-pathologising, positive view of the family system, and the current difficulties they are struggling with. A family system that enters the therapeutic system should be considered as a system that owns a wealth of strengths and solutions in the face of difficult situations. It is important for the therapist to recognise that there is a multi-versa of possibilities available for each family in the process of change, and the family themselves will be in the best position to generate suitable solutions. The therapist can facilitate this process by attending to the strengths and solutions in the stories that the family system brings to therapy.

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3. Outline of Therapeutic Change 3.1 Models of Therapeutic Change In systemic work many different models of change have been hypothesised. In using this manual therapists should consider the model of change outlined in Figure 1. Figure 1. Model of Therapeutic Change

Cybernetics

Narratives

Redundant patterns / beliefs

Meaning through Langauge

Understand patterns / beliefs / stories

Develop different patterns / beliefs / stories Amplify change Therapists are working with families to understand the patterns of behaviour, beliefs or stories that have developed in family systems, and the wider context in which they live. Through the process of understanding these behaviour patterns, beliefs or stories, therapists will begin to introduce new or different information. Therapists may also use active strategies to introduce this new information. The information will affect the development of behavioural patterns, beliefs and stories and the influence they have on the family. It therefore helps the family to develop new perceptions or actions that they can use to tackle the difficulties with which they are struggling. New perceptions that are often helpful to families in achieving change, are outlined in Table 1. Once change is beginning to occur, therapists highlight this process to families, enabling them to develop further changes and develop their understanding of how change was possible. This will develop the familyâ&#x20AC;&#x2122;s resources in coping with future struggles. It will be important for therapists to consider the model of change with which they are currently working and consider what aspects of this model of change they are currently privileging. What is their overall aim during the process of therapy?

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Table 1: Perceptions that are helpful in achieving change Initial Perception of Struggles

Developing Perception of Struggles

Located in the individual

Arising from the system

Uncontrollable/Unchangeable

Temporary

Intrinsic

Accidental

Blameworthy

Redundant

Sinister

Well meaning but mistaken

Linear

Circular

Partisan

Neutral

3.2 Overview of Specific Goals Within each stage of therapy there are also specific goals that the therapist should be considering. The goals are listed here and elaborated within sections 6, 7 & 8.

Goals during initial session 1. 2. 3. 4.

Outline Therapy Boundaries & Structure Engage and Involve all family members Gather and Clarify Information Establish Goals and Objectives of Therapy

Goals during middle sessions 1. 2. 3. 4. 5.

Develop and Monitor Engagement Gather Information and Focus Discussion Identify & Explore Beliefs Work towards change at the level of beliefs and behaviours Return to Objectives and Goals of Therapy

Goals during ending sessions 1. 2. 3. 4. 5.

Gather Information and Focus Discussion Continue to work towards change at the level of behaviours and beliefs Develop family understanding about behaviours and beliefs Secure Collaborative Decision re: Ending Review the process of therapy

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4. Outline of Therapist Interventions Therapists have a range of interventions open to them in working with the family to co-create change. The 4 interventions listed below are those which are most commonly used in systemic family therapy and should be used in therapist’s practice throughout the course of therapy. The degree to which each of these interventions will be used will vary throughout the course of therapy, and therapists’ should follow the guidelines below regarding this. Additional interventions that are used less frequently are highlighted in the appropriate stage of therapy. ⇒ Sections 6, 7, & 8.

4.1 Linear Questioning Direct linear questions can often be useful in gathering information from the system and clarifying information given, especially at the beginning of therapy. Linear questions can be built up in a circular manner around the family by asking different family members the same/similar linear questions.

Linear Questions Examples • • • •

How old are you? Where do you go to school? What do you do if you are upset? What do you do after that?

4.2 Circular Questions Circular questions are aimed at looking at difference and therefore are a way of introducing new information into the system. They are effective at illuminating the interconnectedness of the family sub-systems and ideas. A variety of circular questions may be used by the therapist as outlined in Table 2. These may be more or less appropriate as therapy progresses.

The use of particular types of circular questioning at different stages of the therapy will be highlighted throughout the manual. The time scale of circular questions often changes fluidly between the past, present, future.

Circular Question Examples Type of Circular Question

Examples

About another’s state / behaviour / What do you think John is feeling? beliefs What do you think John is feeling when he shouts at you? What ideas do you think John might have about that? Offering alternative perspectives

What does John think of your school performance? 114

If I asked a teacher what would they say about it? About relationships

- direct - indirect

Do the girls really dislike each other? How do the children react when they see you arguing?

Circular Definitions

When you and John raise your voices and Jill starts crying what does John do then?

About possible futures

What will you think in 5 years time? Miracle question: Imagine you woke up tomorrow morning and all the difficulties you were experiencing currently had disappeared, how would things be different? What effect would that have upon your relationship with x?

Ranking

Who is most likely to get upset when father is away, and who next is most upset? On a scale of one to ten, how close do you think James and Sue feel when they argue?

Though many family members will be able to answer circular questions, and think about information in a circular manner, younger children or those with developmental difficulties, may find it cognitively impossible to view events from another person’s perspective. υ Section 4.5

4.3 Statements Statements are used by the therapist for 3 main functions: • To clarify and acknowledge a communication from the family • To comment on the position or emotional state of a member of the family • To introduce therapist/team ideas, directly or in the form of a reflecting team. υSection 4.4 In using statements therapists should ensure that they are not of long duration, and do not become therapist monologues. Statements should also be delivered in such a manner that they are open to question or comment from the family and not viewed as conclusive statements. Statements are sometimes used as a way of organising information before a question is formulated to the family.

Statement Examples • • •

So let me make sure I have understood this, you feel if you didn’t go out at all, your mum and dad would feel reassured that you would be safe. Have I got that right? I can see this is very upsetting, and remains an area of great distress for you. Who would be most likely to comfort you when you are feeling like this? You were talking a lot about trust, and about how sometimes you had struggled with developing trust as a child, and later as an adult. How much do you feel trust is around now in your relationship with John?

4.4 Reflecting Teams 115

Reflecting teams aim to introduce the therapy team’s ideas into the therapy in a reflexive manner. There are many different models for reflecting teams, and in turn these are often adapted to suit the wishes and needs of the family in therapy. A general model for introducing and implementing reflecting teams is outlined below. 1.

Reflecting teams can be introduced during the therapy session or at the end of the session.

The format of the reflecting team should be negotiated with the family.

The reflecting team may consist of some or all of the therapy team as seems appropriate relative to the size of the team and wishes of the family.

The family should be offered a range of formats including:

•

Reflecting team joining family and therapist in room.

•

Family and therapist observing reflecting team through the one way screen.

In offering their reflections to the family, team members should ensure they: •

are respectful of family, therapist and team members,

•

hold a tentative and curious stance,

•

stay connected to the ideas of the previous contributor,

•

stay connected with the language used by the family,

•

use age appropriate language,

•

do not overwhelm the family with too many ideas,

•

keep the duration of the reflecting team to no more than 10 minutes.

The therapist should take responsibility for monitoring the effect of the reflecting team on the family.

The family should always be given the opportunity to offer their comments on the therapy team’s reflections and ideas.

Feedback should be gained from the family about how comfortable and useful they found the process of the reflecting team, and the ideas the reflecting team shared.

Reflecting Team Example A reflecting team is used at the end of a session with a father, stepmother, and their two teenage children. Much of the session has been focused on the difficulties the parents are experiencing in setting consistent boundaries for the children, especially as they have different parenting styles. They have touched on the transition to becoming a stepfamily. RT1: I suppose what struck me in listening to the discussion today was how much Jean and John seem to have been thinking about pulling together as parents to help give Jack and Jodie clear boundaries of what they can and can’t do in this family, without wanting too come down too hard on their freedom.

RT2: I was wondering how this pulling together process is affected by the fact that John had to do a lot of the decision making and parenting on his own for a number of years. Does it feel like a 116

welcome relief to share things with Jean, or does the extra negotiating make it harder? RT3: I suppose that would depend on what are the family’s ideas about sharing out roles. I mean I was wondering whether they see the role of a stepparent as being any different from that of a parent in their family. RT1: Yes sometimes the roles can be quite different, each one having its pros and cons. Sometimes a stepparent can bring a fresh perspective on things, take a step back and look at things in a different way, like Jean felt she often did. A parent might enjoy a special relationship of understanding because they have been closer to the child for longer. It may be that these differences could be used to complement each other. RT3: I was thinking these things might be influenced a lot by gender, because Jean was saying she and Jodie have developed a closer relationship, partly because they were both women, and there were different expectations of the things Jean might be able to do as a step-mum. RT2: It feels like these things take time to negotiate though, and I wonder if this period of negotiation is what the family are still struggling with, because it might take longer when the children are teenagers, and have plenty of ideas themselves about how things should be. RT1: I wondered what ideas the family had of how to take this negotiation further, if it is something they feel might be worthwhile pursuing. Is it something they would like to discuss here, with us, or do they feel the negotiation will just evolve naturally? Th: Perhaps we can leave it there then, and I will take your ideas up with the family.

4.5 Child Centred Interventions It will be important for therapists to bear in mind the needs of children within therapy session. Interventions will need to be tailored to fit their development level, both cognitively and emotionally. Particularly: •

•

The process and implicit rules of therapy may be particularly confusing and anxiety provoking for children. Engagement should therefore focus on aspects of the world which the child is familiar or is likely to enjoy. Therapists should use a friendly manner, and try not to raise issues which are likely to provoke anxiety. It may also be necessary for therapists to clearly and explicitly explain parts of the therapeutic process which children may find confusing. Questions will need to be adapted so that children can understand the meaning of questions and the form of answers that are required. This may require therapist’s to give concrete examples or use names of individuals to whom they are referring. This is particularly relevant for circular questions which require respondents to take another’s perspective. υ Section 4.2 Children are likely to use multiple channels for communication. It is important for therapists not to rely solely on verbal channels in communicating with children. Drawings, play, and puppetry may all be helpful in enabling children to communicate their ideas, and therapists should be comfortable in using these methods with children.

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5. Therapeutic Setting 5.1 Convening Sessions In setting up the initial therapy session, therapists should begin by discussing the referral information within the therapy team. In deciding whom to invite to the first session attention should be paid to the following factors: • Who is living in the household? • Who else is mentioned as important members of the family system? • Recent family life events, that may affect attendance e.g. childbirth / separation. • Is further information required from referrers before therapy can commence? • What professional systems are involved with the family? In relation to: i. The presenting issues. ii. Other issues, such as child protection. •

Would it be helpful to initiate a professional / network meeting prior to the therapy commencing?

Therapists should first write to the family, using the letter template provided. υ Appendix I. A follow up phone call should then be made one week before the initial session to discuss the therapy. As it is likely that the therapist will only speak to one member of the family during this phonecall, therapists should ask whoever they speak to, to convey the message to the rest of the family. The topics to be covered in the phone call are: • Team working • Attendance issues, who will be coming, how to get there, and ambivalence about attending. • Therapist’s interest in hearing everyone’s ideas • Video recording • Confidentiality

5.2 Team The team within which you are working should comply with the following guidelines: • Include at least two qualified family therapists (eligible for UKCP registration) • One of the qualified therapists should meet with the family whilst the other forms part of the observing team. • Team members should have read and incorporated the guiding principles into their thinking. υ Section 2 • Teams should include therapist and family activities in their observations. • Teams should have at least one method for observing the therapist, e.g. one way mirror, in room observation • Teams should have at least one method of communication between team and therapist, e.g. telephone, earbug, interruptions.

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5.3 Video There should be capacity to video therapy sessions and permission to video therapeutic work should be sought from the family in a manner which clearly discusses the video permission they are granting. υ Section 6.1 - Permission should be confirmed by using the form provided. υ Appendix II.

5.4

Pre-therapy preparation

In preparing for the first session the therapist and the team should meet for at least 15 minutes before the session begins and address the following issues: • Construct a genogram from referral information υ Genogram example • Summarise the main themes from the referral • Consider the recent life events of the family • Consider difficulties which may arise around engagement and how to address these • Consider broader system issues, and define who is in the network • Brainstorm themes/hypotheses/formulations which may be relevant to the family

Genograms Genograms are a means to visually conceptualise the family and wider system, in terms of its members and relationships. They should include the following information: • All members of the family system, including adopted/fostered members • Delineation of the household • All members of the wider system • Dates of birth • Deaths, with dates • Partnerships and marriages, with dates • Separations and divorces, with dates • Pregnancies, miscarriages, and terminations, with dates • Occupations / Schooling Any information that is missing from the referral information should be noted and enquired about during the initial session of therapy. T obias m : 1952 dob: 12.4.27 died : 1967 h ea r t a ttack

Ma r cia

P au l

dob: 20.5.32

m : 1977 d: 1988

54 L eona r d

C ar m el

L eon

B r ia n

dob: 3.6.54

dob: ?

dob: 30.7.55 dob: 13.8.60 J ean dob: ? P ain ter n u r se

J oa n

C har les

dob: ? n u r se

dob: ?

du e : F eb 1999

18 T obias dob: 10.5.80 ban k w or k er

J acob

R ach elle

dob: 19.1.82

14 Monica

dob: 12.2.84

S t J am es G r a m m er S ch ool

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5.5 Pre & Post Session Preparation The therapist and therapy team should allow 15 minutes before and after each session to prepare for their meeting with the family and review the progress of therapy. Issues to be addressed in these discussions should include: Pre-Session • Summary of the main themes from previous session • Information which requires clarification from previous session • Between session contact the therapist has had with the family/wider system • The current formulation/themes/hypothesis of the issues with which the family are bringing • Ways forward for the current session which are being considered • Any team – therapist issues which need to be addressed • Any family – family/team issues which need to be addressed Post-session • Review of main interventions and family’s response • Ideas for future sessions, themes/issues to follow up, E.g. narrative prompts, unexplored areas, facts to check • Feedback to therapist of team observations • Therapist’s reflections on issues evoked for them by the session • Review of important information shared, e.g. life events, elements of genogram

5.6 Correspondence Letters should be used throughout therapy to maintain contact with the family system and the wider network, as illustrated in this manual. υAppendices I, III, IV, V. Throughout this contact, the team’s writing of the letters should always consider the guiding principles outlined in Section 2. Particularly important are issues of connecting with the whole system and not locating pathology within individuals. Particular attention to the language used will be important so that correspondence can be both easily understood, and reflect the contributions of the family to therapy.

5.7 Case notes All written records should be non-pejorative, legible, dated, signed, with no abbreviations. Alterations and Corrections should be clearly marked and signed. Case notes should include: • Family information sheet • Genogram • Referral information/letter • All other written communications to and from the centre • Record of attendance • Sessions notes • Notes on telephone contacts to and from the centre

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5.8 Session notes The therapy team should make session notes for each meeting between the therapist and family/wider system. In this way case notes form an observational record of the process of therapy. Session notes should include : • Date and number of session • Who attended therapy • Therapist/Team member names • Main themes of the session – including key language used by family • Team observations – clearly labelled as impressions • Record of interventions • Key points/ideas/decisions to follow up in later sessions Team members should record session notes on the record form provided. ⇒Appendix VI

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6. Initial sessions Initial sessions of therapy consist of the first and second session of therapy. If a family seems well engaged, and if all of the goals for initial sessions have been covered during the first session, therapists may proceed to the goals for middle session. υ Section 7. If this is not the case therapists’ should continue to focus on the goals for initial session for a second session.

Goals during initial session 1. 2. 3. 4.

Outline Therapy Boundaries & Structure Engage and Involve all family members Gather and Clarify Information Establish Goals and Objectives of Therapy

6.1. Outline Therapy Boundaries & Structure During the initial stages of therapy it is important for the therapist to set the boundaries of therapy by sharing some information with the family / professional system which informs them about the process of therapy, and orientates them to the first meeting. This information is most easily shared by simple statements made by the therapist, these should include:

• Introductions The therapist should introduce himself or herself as a team member and explain the role and context within which they work (the team and the centre). • Team working The therapist should explain that they work as part of a team, and that the team’s role is to generate ideas and help the therapist understand the family / system. The therapist should explain how many team members there are, and the professional background of the team members. The technical equipment used should be explained including the use of the one way screen / phone / earbug. • Video The therapist should explain that family sessions are usually videod, but that the cameras are NOT yet switched on. The purpose of the filming (research / review) should be explicitly stated, as should the storage of videotapes, and who has access to the tapes. The choice of whether to proceed with video should then be given, and the forms completed at the end of the meeting, giving the family a chance to decide then that the video can be erased. υAppendix II • Confidentiality The confidentiality of the videotapes and any information discussed in the session should be outlined. Specific statements about the boundaries of confidentiality should be made in relation to other systems, and with regard to child protection issues.

•

Structure of the session 122

Information should be given on the length of the meeting, the breaks, and the use of team feedback through messages or reflecting teams. Explain that during the break, videoing will stop and the screen will be covered. • Structure of therapy Explain that if the family/team decide to meet again, that the meetings will be approximately every 4 weeks, on the same day, and the same place. Explain that the length of therapy will be decided together by the family / team in accordance with their needs and wishes. • Questions Time should then be spent giving the family an opportunity to ask questions and meet the team. Agreement to proceed with videoing should be confirmed, and the family informed that the video will now be switched on.

6.2 Engage and Involve all family members •

Supportive environment: Initially it is very important for the therapist to provide a warm, supportive and empathic environment, to increase trust and rapport and to build the therapeutic relationship. The therapist must work to help the family feel understood, accepted, comfortable and less anxious. This may include making the room comfortable and safe for younger children, and making it clear they are free to play/draw during the session.

•

Hear from everyone: Therapists should try to hear from all members of the system/family, initially connecting with them all at an individual level, and assessing the level of contribution they feel they are able to make to the discussion, from either verbal or non-verbal cues. The therapist should try to make sure that everyone in the system is able to contribute to the discussion if they wish.

•

Neutrality: The therapist is trying not only to hear everyone’s views but also to establish their interest in different perspectives that may be held within the system. At this point unless serious concerns arise regarding safety/confidentiality the therapist should remain neutral to the difficulties and issues that the family are presenting and their views about them.

6.3 Gather and Clarify Information Information should be gathered by the therapist to orientate them to the system and enable them to hear more about the issues the family is bringing to therapy. Information should be obtained on the following topics: • The Context of therapy: decision to come to therapy, relationship with referrer, previous experiences of therapy, concerns or dilemmas, and their expectations of what would be a successful therapy outcome. •

The System: Gathering information about the system and its relationship to other systems will be important in beginning to develop a broader picture of the family composition, relationships, history, and family patterns. Information should therefore not only be factual, in relation to who is in the system, how old are they etc., but also the relationships and roles they have developed within the system. Information concerning the system should be collated and added to the genogram generated in pre-therapy preparation. υSection 5.4

•

The Presenting difficulties or issues: If the family are introducing information about the 123

difficulties it will be important to follow this up, and open up a wider dialogue about the difficulties, hearing everyone’s perspective. Attention should be paid at this early stage to tracking the behaviour patterns that are defined as difficult, though some exploration of explanations and beliefs that have developed around the difficulties may be appropriate. •

Solutions and Successes to date: It is important to gain some awareness of the actions the family has taken to try and address the difficulties, and their evaluation of the effectiveness of these measures. If the family are finding it difficult to generate concrete examples of things they have tried, hypothetical ideas for future solutions may bring ideas forward for discussion.

Attention should be paid to collecting information in a circular manner. Although it will be appropriate to ask linear questions in collecting information, especially at this early stage of therapy, circularity can be maintained by linking multiple linear questions between family members in a circular way.

6.4 Establish Goals and Objectives of Therapy The therapist should consider with the system what are their goals and objectives for therapy. What are the family hoping to get from the meeting today and the therapy in broader terms, and what are their different views about this and how might this impact on the therapy? The establishment of goals should be achieved in a way which expresses the Possibility of Change, and should convey the expectation that change is possible, and likely to occur, that the therapy team may be able to work with the family towards this. This intention is to build the family’s confidence in their ability to make changes.

Initial Session Checklist for Therapists Now you have finished the initial session/s of therapy: 4 Do you know who is in the family? 4 Have you outlined the way you work and the setting? 4 Have you introduced the therapy team to the family? 4 Have you discussed issues of confidentiality? 4 Have you given the family a chance to ask questions about the therapeutic process? 4 Have you begun to engage all members of the family? 4 Do you know the important people in the wider system/network? 4 Do you have a clear idea of the difficulties/issues with which the family are struggling? 4 Have you heard views of the difficulties from each family member? 4 Do you have an idea of the solutions and strategies that the family have tried so far? 4 Do you have an idea about the family’s strengths? 4 Do you have an idea about what the family would like to change or be different? 4 Have you remembered to obtain written video permission? 4 Have you written to the referrer to inform them of the appointment? υ Appendix III

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7. Middle Sessions Goals during middle sessions 1. 2. 3. 4. 5.

Develop and Monitor Engagement Gather Information and Focus Discussion Identify & Explore Beliefs Work towards change at the level of beliefs and behaviours Return to Objectives and Goals of Therapy

7.1 Develop engagement The therapist should pay particular attention to developing a co-constructed therapeutic relationship. In addition to attending to the three aspects of engagement from the initial meeting (supportive environment/hearing from everyone/neutrality), attention should be paid to: • Creating and offering choices about the process of therapy • Resolving issues in the family-therapist-team system as they arise. This will require therapists to allow sufficient time for team discussions pre and post sessions (υSection 5.5), and time within sessions to discuss the process of therapy with families and any concerns or questions they have in relation to this.

7.2 Gather Information & Focus Discussion Information is still gathered by the therapist, but more of an emphasis should be paid to focusing this discussion, so that issues and areas for discussion from the initial broad discussions may be looked at in greater detail or from different perspectives. The therapist plays a role in developing this discussion to develop themes and keep the discussion focused. Information may often focus on the following topics: •

The presenting difficulties or issues: The therapist will still be gathering information about the difficulties and issues presented. They will look more closely at the consequences/effects of behaviours. They should be tracking behavioural patterns, and giving feedback to the family about the behavioural or emotional interactions and sequences which are discussed or observed. Therapists’ should be collecting this information in a manner that enables circular descriptions of behaviour to develop.

•

The family and wider system: The therapist will still gather information about the family and wider system as is necessary to understand the information and stories being presented by the family. The gathering of information about the family should have reduced considerably from the initial sessions. As the therapist becomes more familiar with who is in the family and their roles, the focus of information should turn more to relationships.

•

Solutions & Successes: The focus on the successes and solutions available to the family should be steadily increasing throughout therapy.

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7.3 Identify & Explore Beliefs The therapist should identify and explore the family’s thoughts, beliefs, myths or attitudes, which may be contributing to their dilemmas and difficulties. The therapist should be beginning to develop a picture of the ideas and beliefs that inform and influence behaviour, as they are gathering a circular description of the difficulties with which the family are struggling. Circular questions which build up circular descriptions of behaviour can also be used to explore the beliefs and assumptions which lie behind those behaviours.

Example: Father and stepmother in the family are talking about their parents’ beliefs about childcare, in relation to being offered numerous solutions from grandparents and friends about how to manage the teenage years. The therapist is trying to explore ideas about childcare, where these have developed from, and how they might develop in the future. Fa: Well my mother would have a lot to say about that. I mean if we were ever like that there was a firm hand. We would have never have got away with it. Th: And where do you think your ideas and values about how to manage the children come from, your own parents? Fa: Well, not really so much from my parents, I mean I would disagree with a lot of their ideas about how to do things. I think really I have got more of my guides from the church, that’s what has really shaped me. Th: And when was it you started to take on the ideas of the church. Fa: Well I suppose in my late teens, early twenties really, but I have always been interested. Jane (stepmother) has been going since a child and I would say your family were more strongly Christian than mine were, wouldn’t you? Mo: Yes, I have always gone to church. Th: What are the values from the church that have influenced you as parents? Mo: Well really a sense of sharing, we feel it’s important for us both to take some interest in the children, and show them we care, not just one or other of us. But, I don’t know whether we always manage it. Th: (to the teenage children) When you two are parents where do you think your values will come from? Son: Well neither of them, well… I suppose I am a bit like dad, maybe I’d be a bit like him. Th: (To son) And if you were a parent, in their situation as parents now, what might you advise them to do?

The exploration of family beliefs should be used by the therapist to look at a range of family activities, and not just the presenting difficulties. Therapists should explore the family’s beliefs in relation to: •

The presenting difficulties. E.g. What ideas has your wife come up with to explain the behaviour John is showing? How do you understand the idea that James is less concerned about the behaviour than Jill? 126

•

Relationships within the family and with the wider system. E.g. Who feels it is most important to keep liasing with the school over this issue? What would your church say about how families cope with loss and bereavement?

•

Solutions that have been tried or hypothesised. E.g. What gave you the confidence to keep going with this new idea? What gave you the idea to try and tackle things in this manner?

•

Successes in all areas of family life and relationships to the wider system. E.g. Would that be judged as a success in your family? If John’s grandparents were here would they see that as a success, or would they have different ideas about success?

•

Therapy process, beliefs about therapy E.g. What led to your decision not to bring the children to today’s meeting? In what ways do you think Jill was disappointed with the therapy she went to last year?

•

Family behaviour during therapy. E.g. Jill is looking distressed, what do you think was so upsetting for her in talking about the difficulties you are experiencing? How do you understand John’s anger with the way that things have gone in today’s meeting?

7.4 Work towards change at the level of beliefs and behaviours •

Challenge existing patterns and assumptions: To move with the family to a position where they are able to query their own beliefs, perceptions and feelings. The therapist should actively query the family’s existing beliefs, assumptions or behaviours. The use of circular questioning, alternative perspective and possible futures questioning may be particularly helpful in achieving this.

Example: A 12-year-old child (John) is discussing how he feels to blame when things in the family go wrong, or there are arguments between he and his mother. The therapist begins by clarifying what are the child’s assumptions, then begins to challenge some of the linear aspects of them. John: Well I know it must be me, cause I am the one who always gets shouted at. Th: So do you sometimes feel you are to blame for things that happen at home? John: Well mainly. Th: Who would be able to convince you otherwise? John: Well sometimes Nan says things are not my fault, and that me and mum should listen more to each other, but, I figure it must be me or mum who is at fault. Th: Does it have to be either your mum to blame or you to blame? John: Well I don’t know, we are all right together sometimes. Th: How would your Nan explain the times when you and your mum do get on well together? John: Well she says we are alright when we stop and listen, sometimes we can just bite off each other’s heads you see, over nothing, when no-one has really done anything wrong.

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•

Provide distance between the family and the problem: Providing distance to try and free the family from the pressure of the difficulties, so that they are more able to consider and reflect upon them. Alternative perspective circular questions and those aimed at looking at possible futures can often be helpful in achieving this.

Example: The therapist is talking alone to a mother who has been attending therapy with her children. Since the separation from her partner she has been finding coping with the demands of the childcare increasingly arduous, and at times has felt very low about her ability to carry on and cope. The therapist is trying to work towards creating some distance between the mother and the situation in which she finds herself, to allow a space for reflection on the position she is in. Mary: Sometimes I feel so inadequate as a mother, I find myself constantly doubting my own judgement. Th: If we met with a group of single parents, do you think that would be a concern for most of them? Would they say making parental decisions alone is very demanding because they may not have immediate confirmation from another adult? Mary: Well maybe, but it is so hard because though there is not another adult there, the children are quick enough to say, other mums don’t do that, or so and so’s mum would let them do this or that. Th: When your children grow up, do you think they will more fully appreciate the job you do, and your determination to do your best by them? Mary: Well I hope so, I think sometimes they know now how hard things are for me on my own, how much more running around I have to do, and sometimes how exhausted I am. Th: When they become parents of their own children, do you think they will see how hard you have been trying to be both mum and dad at times?

•

Externalise One specific way of providing distance between the family and the difficulties, which is particularly useful if the difficulties are seen to reside within one family member is to externalise the problem. That is to give the problem an external, objective reality outside of the person. This can be useful in mobilising the family’s resources to unite in working towards solutions and new ways of thinking which challenge the difficulties.

Example: The therapist is talking to a 10-year-old boy (Max) during the course of a family meeting. Max has been describing how bad tempered he can be, especially at school. Family members have been agreeing that Max is bad tempered. The therapist is working to externalise the temper from Max, in order that he and his family find ways they can have an influence on the tempers. Th: Can we give this bad temper a name? Max: Well, it’s a sort of me at my angriest, a mad max I suppose. Th: When mad max is around, what effect does he have on your friendships at school? Max: Well, that when it can be at its worst, mad max can get me to be very argumentative, my friends stay well away from me. Th: So when mad max is around they stay away. What happens when mad max isn’t there? Max: Well I tend to play football with my mates.

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•

Reframe: Reframe some of the constraining ideas presented by the family. Relabelling in a positive way, ideas and descriptions given by family members, in a manner which is consistent with their realities. Circular questions are often most helpful in opening up reframes with the family.

Example A father is defining himself and his parenting behaviour as the ‘problem’ in relation to his children’s teenage struggles. The therapist works towards redefining the descriptions of behaviour as less problematic and offering some positives for the family. Cl: I think I’m basically just too inconsistent, it depends what mood I am in, or how busy I am, as to what answer the kids will get from me. Th: I am just wondering, this inconsistency, who is it a problem for? Cl: Well them, I think. They don’t know where they stand half the time. Th: Does it leave people not knowing where they stand or does it leave people having to make up their own minds? Cl: Well both, I’ve never really thought about it like that, but I feel like I don’t always think before I react. Th: Tell me Jane, what are some of the helpful things about your dad just reacting sometimes?

•

Open up new stories/explanations: Either by facilitating the family’s evolution of new ideas and narratives, or by the introduction of these ideas by the therapist. All family members will have stories about their lives, the lives of other family members, and the life of the family. They will prioritise certain information from the world around them to build these stories and neglect other aspects. Exploration of neglected information may open up the development of stories which are more helpful to the family in coping with their concerns. Information which is neglected often concerns: • Successes • Solutions • Exceptions • Alternative views from the network • Other strengths

The therapist should pay particular attention to enquiring about this information as therapy progresses, using circular questions so that the information is provided in a non-threatening manner. Often circular questions, which are aimed at offering alternative perspectives, can be helpful to this aim. As information is likely to remain neglected by the family even if introduced into the therapeutic conversation, it can often be helpful to emphasise neglected information by therapist statements and reflecting team messages. Example: Mother: Cindy has always wanted to be a nurse. She entered nurse training but as usual she made a mess of it. She always does things the hard way. She continued to dream of going away to college, and get on in some way even after she had failed her exams. She is now doing volunteer auxiliary nursing. Th: She has continued to work as an auxiliary nurse, she really sounds determined. It seems impressive that she has found another way to fulfil her ambition, and not let herself get discouraged. Where does she get that determination from?

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•

Elicit Solutions: It will be helpful to gather information from the family about solutions for the difficulties that they have tried or would consider useful. Ideas generated by them are usually most helpful and linear questions are often used to develop an overview of solutions that the family have tried or thought of. If the family are finding it difficult to generate successes circular future orientated questions – such as the miracle question - can be helpful. However at times it may be useful for the therapist or therapy team to offer ideas to begin a process whereby the family can generate solutions. If this is necessary ideas should be tentative and flexible enough to allow the family to disregard them or build upon them.

Example: The therapist is talking to a mother and her three children. They are having difficulties getting along together, which is intensified by the cramped living accommodation, and their feelings that they don’t have space for themselves. Th: So it seems important for you to be able to keep things private, to have space that is your very own. What ideas have you come up with to achieve this? Mo: Well we tried letting the children lock their rooms, so that they wouldn’t be in and out of each other’s rooms, arguing about stuff. But it’s just seemed to cause more arguments, they would just stand outside each other’s doors screaming to be let in. Th: So what else did you try then? Mo: Well we have tried just about everything, you name it we have tried it. Th: Jane, what does your mum mean? Tell me a bit more about all the things your family have tried. Jane: Well when the keys got taken off us, I said Jack and Jodie had to knock on my door, but they never did, especially him. So mum said we would have to play down stairs all the time, which didn’t last long, because when I had a friend round I wanted to go upstairs. Th: So Jack, your sister says you have all being trying hard with ideas about this, can you tell me any other things that have been tried? Jack: Nothing else. Th: Well can you think of other things you think might help which you haven’t tried yet? Jack: No, nothing seems to work. Th: Imagine in a month’s time Jane and Jodie had stopped coming into your room, what would have had to happened to make that possible? Jack: Well mum might have really told them off when they did it, and said no TV and stuff like that. Th: Jodie do you think that would stop Jack coming into your room if your mum said that to him? Jodie: No, he would do it anyway. Th: What do you think might help Jack to stop coming in? Jodie: No computer.

•

Amplify change: In order to maximise the change or potential change that is occurring throughout the course of therapy it will be important for the therapist to focus on statements the family present about progress. Initially these aspects may be minimal, or presented in a manner by the family which denies the magnitude of the effort or progress they have made. The therapist should focus on descriptions of actions where the family could be seen to have initiated or implemented change, in a manner which is positive but sensitive to the family’s level of confidence that change has occurred. 130

Example: A 10-year old boy (Jake) is talking about a time when he and he had been pleased about his behaviour, against a context of difficulties in relationships and communication with his father, as well as difficulties at school. The therapist explores the event in more detail to emphasise the success and implications of this for their relationship. Jake: Well last Thursday we went to the park, and I went on a school trip, and we got to go on a fair ride, and the teacher said I had been really good. Th: That sounds like a really nice time, does your mum know about this? Jake: Yeah, I told her what the teacher had said. Th: How did your mum react to the good news? Jake: She was pleased I think. Th: How did you know? How could you tell your mum was pleased? Jake: She looked quite happy, and she said we could go to McDonalds on the way home. Th: (to mother) So you were able to show Jake how pleased you were, how did you feel he responded to that? Fa: I was quite surprised actually, we went to McDonalds and he didn’t play up at all, and he told me about the day, which is a bit of a first for him. Th: So you noticed you were able to talk more together, what made that possible? Fa: Well I don’t know, really. Th: Did you notice you were more relaxed at all? Fa: Well I suppose that did help, we had a bit of time together because we were out just the two of us, and I wasn’t wound up so much, cause I was really pleased that he had behaved himself all day? Th: What would make it possible for you to both find other times in the week when you could have a bit more time just the two of you, to feel more relaxed and talk.

•

Enhance mastery: To encourage the family to gain a sense of mastery or control over their situation, their thoughts, feelings and behaviours. This should enable the family members to take responsibility for their own roles and actions, and for the process of change. In addition should enable family members to gain an awareness of the actions and motivations of other people in their family in achieving change.

Example: A mother and her two children aged 5 and 7 years are attending a late middle session of therapy. The parents separated 3 years ago, and the mother has been finding managing the children’s behaviour difficult since this time. The therapist and family have been working together through the therapy to identify the things that the mother is doing well in relation to managing the children’s behaviour and managing her own low feelings. The therapist is commenting on this process and highlighting the mother’s own stories of competence which are often lost. Mo: Well I feel like things have been going quite well with the kids, they have been behaving really well most times, but I don’t know sometimes I still feel low, I wonder whether I am doing ok. What do you think? Th: We would predict many of the things you have been telling me about today, about things being up and down at this stage. I hesitate to advise a family who have come up with such good ideas and solutions on their own. Especially when most of them seem to be having the desired effect. What have you been thinking of trying most recently? 131

Mo: Well I’m not sure sometimes I feel it’s right to take a sympathetic approach to the kids, then other times I come down on them hard, you know, if they are playing up. Th: If Josie (mother’s friend) were looking in on how you were managing them now, would she say you are combining these two approaches, or are you sticking with one or the other? Mo: Well she’d see a mix of the both I think, I mean I try and judge each situation as it comes. Th: So do you feel you are becoming more confident in trusting your judgement about what is right for the kids and when? Mo: Well a bit yes, I mean they don’t pull the wool over my eyes, I know when they are just playing up or when they are really upset. Th: So when did you decide to be a bit more flexible about how you dealt with the situations at home?

•

Introduce therapist/team ideas: May include the therapist sharing their ideas and hypothesis about the family, individual, or difficulties, for a variety of reasons. Including: • Normalise difficulties • Move the family to new ideas • Connect family’s ideas • Suggest ways to organise the discussion, e.g. Enactments.

Example: A mother, her social worker and the therapist are having a session. The mother begins to discuss her experiences of violence from her ex-partner when she was first married, in her early twenties. As the mother is taking a rather critical stance towards her own actions at that time, the therapist normalises her reactions to the violence, to try to begin to open up less critical stories and reframe the mother’s actions at the time as understandable rather then ‘weak’. Mo: I suppose I should have been stronger, and not let him trample all over me. My mum used to say just get out, leave him, and I did for a while, I did try, but then I weakened and let him back even though I thought why I am I doing this? What about the kids? I really should have tried to be stronger. Th: Was your mum the only person with whom you shared this? Mo: Well I tried to talk to my friend but I felt a bit bad, because all the same stuff had happened to her, and I just told her to leave and lost patience with her, and then I ended up being just as weak as she was. Th: From talking to other women who have lived with violence like you have, I often hear a similar story that they feel they should leave, but it is easier said than done when you are living with that fear on a day to day basis. Mo: That was it really, the fear, it kept me weak, and I loved him. Th: Women tell me they hold onto a hope that if only they did a bit better, were a bit stronger, their partner will change, so they keep trying over and over again. Did that happen for you? Mo: Yes, I took him back more than once you see, lots, but then I thought no more, not with the kids seeing things and all that. Th: What gave you the strength to put the kids first, and keep sticking to it?

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7.5 Return to Objectives and Goals of Therapy The therapist should return to the issues of goals for therapy as therapy progresses: i. If goals seemed unclear during the initial stages of therapy, it may take some time and thought with the family for them to consider the areas they want to change in therapy, or to find priorities for change. ii. If goals are achieved, so that goals can be renegotiated, perhaps for change at a wider system level, or a decision to move towards the end of therapy is made iii. If goals change due to changing circumstances for the family. Example: Things are beginning to improve for a family whose initial concerns were the suicide attempt made by their daughter. She is no longer suicidal and seems to be getting happier at home and at school. The therapist discusses with the family whether they are happy with this progress, and whether they are left with other issues they would like to bring to therapy. Fa: I mean I think we are all lot more relaxed about Janice now, she was in her room for hours at the weekend, and I realised at the end of the day that I hadn’t gone and checked on her once, and I figured that was because I was beginning to trust her again, I mean I didn’t have to watch her every 5 minutes, or worry what she was up to. Th: So it seems like all of you are feeling that your concerns that Janice will harm herself are less now, and Janice you said you felt a bit happier at school. Now these changes are taking place, has it left you with different ideas about what it could be helpful for us to discuss here? Janice: Nothing much else to say. Th: John do you think there are things which Janice might appreciate us talking about here? John: Well I know she doesn’t like talking about it, and I think that’s half the trouble, but I think maybe we need to think about how to help Janice cope with all the stuff that goes on at school, all the bullying. Th: Janice, is that one of the most difficult things for you to talk about? Janice: Yes. Th: Would it be helpful to think with you and your family how we could make talking about it easier? Janice: I’m not sure, there is nothing they can do anyway. Fa: Me and your mum think if you could talk a bit though, you would like have a shoulder to cry on and not feel alone. Th: Do you feel you mum and dad might be able to help support you Janice? Janice: Yes I suppose so, I did talk to mum once and I felt better. Th: Would that be something we could try to develop here. Janice: Well I will give it a go.

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Middle Sessions Checklist for Therapists Now you are nearing the end of the middle sessions of therapy: 4 Have you continued to engage the family in the work together? 4 Have you addressed problems in working together as they have arisen? 4 Have you developed a circular description of the interactions and difficulties with which the family are struggling? 4 Are you developing a clear idea about the strengths and resources the family are drawing upon? 4 Are you working with the family to generate new solutions for the issues they are bringing? 4 Have you begun to explore the familyâ&#x20AC;&#x2122;s beliefs and ideas about the interactions and relationships in their family? 4 Has there begun to be a shift in the interactions in which the family are engaged? 4 Have you challenged the familyâ&#x20AC;&#x2122;s beliefs about the issues that they are discussing? 4 Have you worked with the family to open up new stories/explanations about the difficulties they are experiencing? 4 Have you worked to reframe the difficulties or struggles that the family are experiencing? 4 Have you introduced distance between the family and the difficulties or tried to externalise the difficulties? 4 Have you tried to amplify the successes and change that the family achieved? 4 Are you working with the family to try and increase the sense of mastery and control they feel they have over the difficulties? 4 Have you reconsidered with the family if they are achieving change in the way they had hoped? 4 Have you written to the referrer to inform them of the progress of therapy? Ď&#x2026; Appendix IV.

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8. End sessions Goals during ending sessions 1. 2. 3. 4. 5.

8.1 Gather Information & Focus Discussion Information gathering and focusing the information brought by the family to sessions is still important towards the end of therapy, though the focus of the information is likely to be considerably different.

•

The Presenting difficulties or issues: There will still be a lot of information shared about the difficulties with which the family are struggling, though the focus will be on changes that have arisen concerning these issues over the course of therapy.

•

Solutions and Successes to date: There should be a considerable amount of discussion about the solutions that the family are now implementing in relation to the difficulties, as well as the successes they feel they have achieved so far, and those they are looking forward to in the future. If the family are slipping into focusing on the difficulties, it will be important to enquire further about the successes about which the therapist has heard over the course of therapy, which the family are currently neglecting.

•

The System / Wider system: There should be a considerable decrease in the amount of information shared about the system and wider system. Of the information that is shared it is likely to be in relation to how the difficulties are showing/decreasing in other contexts. Also supports in the wider network which may be drawn upon once therapy has concluded are often explored.

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8.2 Continue to work towards change at the level of behaviours and beliefs As in middle sessions the therapist and family are continuing to work towards change at the levels of belief and behaviour. The methods they use can incorporate any of those highlighted in the middle session. See section 7.4. However it is more common in end sessions for the focus to be on the following methods: •

Amplifying change: In order to maximise the change or potential change that is occurring throughout the course of therapy it will be important for the therapist to focus on statements the family present about progress. Initially these aspects may be minimal, or presented in a manner by the family which denies the magnitude of the effort or progress they have made. The therapist should focus on descriptions of actions where the family could be seen to have initiated or implemented change, in a manner, which is positive, but sensitive to the family’s level of confidence that change has occurred.

•

Enhancing mastery: To encourage the family to gain a sense of mastery or control over their situation, their thoughts, feelings and behaviours. This is to enable the family members to take responsibility for their own roles and actions, and for the process of change. In addition should enable family members to gain an awareness of the actions and motivations of other people in their family in achieving change.

•

Challenging existing patterns and assumptions: To move with the family to a position where they are able to query their own beliefs, perceptions and feelings. The therapist should actively query the family’s existing beliefs, assumptions or behaviours. The use of circular questioning, alternative perspective, and possible futures questioning may be particularly helpful in achieving this.

•

Reframing: Reframe some of the constraining ideas presented by the family. Relabelling in a positive way, ideas and descriptions given by family members, in a manner which is consistent with their realities. Circular questions are often most helpful in opening up reframes with the family.

•

Developing new stories and explanations: Either by facilitating the family’s generation of new ideas and narratives, or the introduction of these ideas by the therapist. All family members will have stories about their lives, the lives of other family members, and the life of the family. They will prioritise certain information from the world around them to build these stories and neglect other aspects. Exploration of neglected information may open up the development of stories to become stories that are more helpful to the family in coping with their concerns. Information which is often neglected often concerns: • Successes & Solutions • Strengths • Exceptions • Alternative views from the network

8.3

Develop family understanding about behaviours and beliefs

As therapy ends it will be important for the therapist to work with the family to develop and encourage their understanding of the process of the development of difficulties. This may be helpful in equipping the family with the ability to recognise the development of such processes in the future. Particular attention should be paid to: • Underlying family interactional patterns. • Motivations for assumptions, behaviours and feelings. • Understanding of a family member’s reactions to other’s behaviours. 136

8.4

Collaborative ending decision

The timing of ending is not always obvious and in aiming to make the ending process a collaborative process the therapist and therapy team should be alert to a number of signals in sessions which may indicate that therapy may soon draw to a close. These include: •

Positive feedback from the family: the family situation or the issues they presented are reported as improved or improving. The family report having made changes in other areas of their lives.

•

Negative feedback from the therapy: The family report dissatisfaction about the therapy, or the progress they are making. This is often done through expressing the views of a family member absent from therapy.

•

Therapist notices changes: Missed sessions by the family. Changes in the level of engagement in therapy. Therapist notices positive changes in the way the family are interacting during sessions, for example they are beginning to use new narratives, or are beginning to comment in a different way on their relationships and the issues with which they are struggling. The relationship to therapy may change, with the family becoming more confident in their own abilities, resources and solutions, and attributing change to this.

If it seems that ending therapy is indicated it is important for the therapist to hear from everyone their thoughts and feelings about ending therapy and make this a collaborative decision. To do this the therapist and therapy team must share their thoughts about ending with each other and the family. The team should consider the following issues and then gather the family’s views on these. •

Whether the family might feel it was appropriate to end therapy, do they feel they have achieved what they set out to achieve?

•

How might the family prefer to end therapy, would they like a follow up appointment or would they like to re-contact the team if necessary?

•

Might the family feel it would be important to engineer systems of support, before therapy ends?

•

With whom should the team share information about the therapy and what has been achieved, e.g. referrer, school.

•

A useful and engaging way of saying goodbye to the family.

Once this information has been shared decisions should be reached about: • When therapy will end. • What follow up arrangements will be made. • What the family might do if difficulties should arise again. • Who will be contacted post therapy.

8.5 Review the process of therapy It will be helpful for the therapist to invite the family to review the process of therapy. This may be useful for the team and family in relation to prevention of future difficulties, and to empower the family in any future contact with therapeutic services. Issues that should be considered include: • What has been gained/lost for the family through therapy? • Any misunderstandings not addressed during therapy should be clarified and addressed. • Reasons for therapist’s behaviours and procedures used. • What might the family do differently if future difficulties arise?

End Sessions Checklist for Therapists 137

Before you end therapy check: 4 Do the family have an understanding of the issues which they are happy with? 4 Are the family happy with the ways of interacting that they are currently developing? 4 Have you continued to amplify change, enhance mastery, challenge existing patterns and assumptions, reframe concerns and difficulties, and develop new stories and explanations of difficulties? 4 Have you discussed ending therapy with the family, and listened to their wishes about ending? 4 Have you reviewed with the family the goals outlined in the initial and middle stages of therapy? 4 Have you considered contingency plans for the family when future difficulties arise? 4 Have you reviewed with the family what was useful and not useful about therapy? 4 Have you discussed how to re-engage with therapy if required? 4 Have you written a closing summary of the work to the referrer? Ď&#x2026; Appendix V

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9. Indirect Work There are many areas of systemic work, which although they do not directly involve the presence of the family, are essential in supporting the ongoing work with the family. Directions for conducting this non-direct work are therefore outlined below. Therapists are reminded that the guiding principles outlined at the beginning of this manual will also be applicable to the non-direct work outlined in this section.

9.1 Child Protection Therapists should abide by the local child protection procedures outlined by their area. Wherever possible the local procedures should be carried out using the systemic principles described in section 2. It may be necessary to move from the domain of therapy to the domain of protection but the manner in which this is achieved should retain a systemic focus, and not preclude the possibility of moving back into the domain of therapy at a later stage. Therapists should inform the family that they are now not talking with them in their therapeutic role as they have serious concerns about the safety of a family member. Particular attention should be paid to bearing the needs of the system in mind whilst still prioritising the needs of the child for protection, the language and narratives about abuse and protection, and the co-construction of the relationship. If at all possible, without placing the child at further risk, therapists should discuss the child protection issues with the family, and keep them informed of any protective procedures that the therapist is to instigate.

9.2 Clarifying therapy with referrer present In situations where referrals are vague, complex, or involve a network of professionals, it may be necessary to clarify the nature and boundaries of the referral over the telephone, or in person. This ideally should be done with the referrer and family at a pre-therapy meeting, where the multiple views about therapy, its utility and limits, can be shared between all members of the system. However in referrals where there may be tensions in the referring relationship, or issues of advocacy may limit the family’s ability to communicate their ideas and wishes, separate contacts should be used to clarify therapy, before therapy commences.

9.3 Identifying the network and clarifying relationships It is important for the therapy team to identify the components of the family’s network from the referral information given and during the assessment process. This includes professional and extended family contact, as well as other relationships, friendships and occupational aspects of the family’s life. This should be done for current relationships as well as important contacts in the family’s history. Important life events such as illnesses, hospitalisations, and periods of separation can be built into this picture. This information should be used in relation to the therapeutic goals and in relation to contact with the wider system that the therapy team and family participates in during therapy. If the family are participating in any other therapeutic activity during the time they are attending family therapy, for example individual or couple therapy, the boundaries of the work should be clarified in relation to the current goals for family therapy. In addition, in identifying the network and clarifying relationships, the boundaries of confidentiality and the family’s wishes concerning this should be discussed and clearly stated to all members of the network.

9.4 Assessing risk At times during therapy it will be necessary to consider the risk which one or more member of the family poses in relation to their own well being or the well being of a family member. The risk 139

may be in relation to a number of issues, for example, child protection, domestic violence, or suicide attempts. Therapists should bring their concerns into the discussion with the family to hear their own views of the risks. It is important that the therapistâ&#x20AC;&#x2122;s and familyâ&#x20AC;&#x2122;s concerns are identified, in a manner which opens up communication and leads to the establishment of contingency plans to monitor or prevent further risks. In relation to suicidal ideation it may be necessary for the therapist to move outside the domain of therapy and complete a full psychiatric risk assessment, or refer to someone able to complete this. Again this should be a process in which the family are actively involved and therapists should inform the family that they are now not talking with them in their therapeutic role as they have serious concerns about the risks to a family member.

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10. Proscribed Practices The proscribed practices described below are things that would not be included in a routine therapy session. It may be that on one or two occasions it is appropriate to use one of these approaches, however they must be used within a systemic framework, that is, using the guiding principles outlined at the start of this manual. Team members should monitor sessions for proscribed interventions, and record these, together with any justification, in session notes? â&#x2021;&#x2019; Section 5.8

10.1

Advice

As a systemic therapist you would not usually offer direct advice to the family about their interactions or the difficulties they are experiencing. If the family ask for advice about a particular issue with which they are struggling or the therapist feels advice may be appropriate in helping the family work towards their goals, advice may be offered in a non-directive or reflexive manner. Options should be presented as choices about which the family can make their own decisions.

10.2 Interpretation Psychodynamic interpretations about the meaning of symptoms or interactions in relation to individual or trauma would not be usual for systemic therapists. Rather, meanings are explored in relational and interactional terms between members of the system.

10.3 Un-transparent/Closed Practice Therapists should not remain closed about their working practices, ways of thinking and understanding the difficulties with which the family are struggling. They should try to remain transparent by explaining their practices at the beginning of therapy, and during therapy as appropriate.

10.4 Therapist monologues In the co-created process of therapy therapists should not find themselves lecturing or using long monologues in their interactions with the family. The process should be more like a sharing of ideas between therapist and family, and between family members.

10.5 Consistently siding with one person In taking a neutral stance therapists should not find themselves consistently siding with one person in the family. It may be necessary at times, for ethical or therapeutic reasons, to align oneself with a member of the family, but if therapy is to continue, this should not be a constant state.

10.6 Working in the transference Therapists should be paying attention to the relational and engagement issues between themselves and the family with which they are working but they should not use the relational aspects between themselves and the family as the tool of therapy, that is work within the transference.

10.7 Inattention to use of language Therapists should not be inattentive to the use of language used by the family. They should pay attention to the both the words and phrases used, and the meanings attributed to these.

10.8 Reflections Therapistâ&#x20AC;&#x2122;s simple reflections of the points or phrases that are used by the family should be kept to a minimum. Reflections may be used to enhance engagement and to develop the familyâ&#x20AC;&#x2122;s sense of 141

being listened to and understood, but when used, reflections should be followed by questions, and increased curiosity about the issues presented.

10.9 Polarised position Therapists should avoid taking a position which is polarised from that of the family, or a position which is likely to escalate to a polarised position. Therapists should be thinking about how to take a position which connects to the ideas of the family, whilst still questioning those ideas, and allowing them to remain curious. The therapeutic team can enable the therapist to achieve this by presenting the multiple perspectives from which the family situation can be understood.

10.11 Sticking in one time frame Therapists should not stick in one time frame, but move the focus of their questions and discussion between the past, present and future.

10.12 Agreeing / not challenging ideas Therapists should not be in a continual state of agreement with the familyâ&#x20AC;&#x2122;s ideas. They should remain curious and challenging about the nature and content of these ideas, in order to introduce new unexplored possibilities and ideas.

10.13 Ignoring information that contradicts hypothesis Therapists should not ignore, or minimise information presented by the family which contradicts their own ideas and hypotheses, rather they should take this information seriously and use it to modify and expand their working ideas.

10.14 Dismissing ideas The ideas presented by the family about the difficulties with which they are struggling, or the process of therapy itself should not be dismissed by the therapist.

10.15 Inappropriate affect The therapistâ&#x20AC;&#x2122;s affect should match that of the family, and would be considered inappropriate if it remained dissimilar from family for an extended period of time. One example might be if the family were feeling optimistic about change and the progress they were making, and the therapist remained pessimistic. There may be times, when a mismatch of affect is used transiently, in order for the therapists to take a position in relation to the family as a way of questioning or challenging their ideas.

10.16 Ignoring family affect Therapists should pay attention to the affect that the family is showing in the session, and not ignore strong expressions of affect during the sessions. This may be particularly relevant when a member of the family shows distress during the meeting, either by sad or angry behaviour.

10.17 Ignoring difference Therapists should not ignore issues of difference between themselves and the family or within the family. These may be differences in views, beliefs, gender, abilities, class or race, and should be raised by the therapist in a sensitive and open manner for further exploration.

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Appendix 1: Sample Appointment Letter Appointment letters should include: • • • • • • •

Referral source and name of referrer Invitation to the whole family Reasons why all the household should attend Date, time and place Confirmation request Brief explanation of teamwork Main therapists name

Dear Mr & Mrs Smith & Jodie and Jonathan, We have heard from your GP, Dr. Jones, that it might be worthwhile exploring whether family therapy could be of help to you all. We would therefore like to offer you an appointment to come along and meet us at our Family Therapy and Research Centre on Wednesday 13th July at 4.30pm. This first session would be to discuss the issues that concern you and to decide whether family therapy might be useful. We find it helpful to meet all members of the family or household so that we can learn how things are from everyone's point of view. We hope to see as many of you as possible for this first appointment. We work as a team in order to generate more ideas which we hope to share with you. There are about 5 people in the team, but the person who will be talking with you most directly is Dr. Peter Stratton. Enclosed is a map giving directions to the clinic, which is situated in the Department of Psychology at Leeds University. Please let us know whether or not you can attend, as soon as possible by telephoning our secretary on the above number. It is important that you give us this information as we have a waiting list for appointments. Yours sincerely,

Dr Peter Stratton Family Therapist On behalf of Leeds Family Therapy Team

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Appendix II: Sample Video Consent Form Consent Form for the Use of Video Tape We give consent for the use of these video recordings for the following purposes: 1. To help the team deliver a more effective service to our family. For the purposes of supervision and in order to plan future therapy sessions. Confidentiality will always be maintained. Viewing will be confined to the regular members of your family therapy team. 2. For teaching & research, in order to develop our service through training other therapists, and improving the service for families through research. Such tapes are only shown to audiences of professional clinicians and researchers who are warned about the importance of confidentiality.

Please delete as appropriate.

Signed: ………………………………………………………………………… …………………………………………………………………………………. Dated: …………………………………………………………………………. You are entitled to change your mind about the consent given above at any time. All video material is stored in locked cabinets and every effort will be made to ensure confidentiality. No video material will be identified using your family’s name. Signed: ………………………………………………………………………… …………………………………………………………………………………. All Family Members Dated: …………………………………………………………………………. Member of Family Therapy Team

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Appendix III: Sample Referrer letter This letter is to be sent to the referrers when first appointment sent out. It should include: • • • • • •

Referral date Referral reason Family name & address Date of appointment Proposed future contact Contact person

Dear Dr. Jones Re:

Smith Family 11 James Avenue, Leeds, LS2

Further to your referral of the Smith family, for help concerning bereavement issues, in March 1998, we have offered them an appointment at the Leeds Family Therapy and Research Centre on Wednesday 13th July at 4.30pm. We will keep you informed of their progress should they go ahead with family therapy. If in the meantime you have any further issues regarding this family please contact Dr. Peter Stratton. Yours sincerely

Dr Peter Stratton Family Therapist On behalf of Leeds Family Therapy Team

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Appendix IV: Post-assessment letter to referrer A letter should be sent to the referrer once an assessment is completed or when the initial goals of therapy are clarified with the family. This letter should include: • • • • • • • •

Number of assessment sessions attended Who attended Brief family composition Referrers concerns Family’s concerns Systemic Formulation/Understanding of Difficulties Agreed Goals for Therapy Agreed liaison with other systems

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Dear Dr. Jones Re: Smith Family - 11 James Avenue, Leeds, LS2 I have now seen the Smith family on 2 occasions following your referral for help with bereavement issues following the death of the eldest child in the family, Julie. Mr & Mrs Smith attended alone for the first meeting, as they were concerned to give us a picture of the difficulties without upsetting the children. This was followed up with a meeting with the whole family. As you know the family consist of Mr & Mrs Smith, and their 2 children Jodie (6 years) & John (9 years), both of whom are attending Jacob School. The eldest child of the family, Julie, died in a car crash in September 1997. Mr & Mrs Smith outlined to us their concerns that their children were expressing no grief relating to the death of their elder sister Julie. They were concerned about how the loss was affecting them in both their achievement and behaviour at school, and expressed a wish that they were more able to talk about the issue as a family. The children were quite cautious about discussing this issue initially, and expressed a desire not to upset their parents further by talking about Julieâ&#x20AC;&#x2122;s death. It seemed that although this was a topic all the family felt would be helpful to discuss more openly, no one dared to begin the conversation, as they were concerned not to bring further distress to members of their family. The children had carried this silence to school, and would not talk to any of Julieâ&#x20AC;&#x2122;s old friends about her, yet consistently showed distress through their behaviour and lack of concentration. It was therefore decided to try and begin to talk about Julieâ&#x20AC;&#x2122;s death and the impact this had had on the whole family in our meetings. The children very much wanted this to be at their pace, and we have been thinking with them about ways to help the process of talking easier. We also plan to make links with Jacob school, to discuss how the children might show their distress in different ways at school. I will contact you again once therapy has ended to discuss the utility of these interventions for the family. Yours sincerely, Dr Peter Stratton Family Therapist On behalf of The Leeds Family Therapy Team

Appendix V: Closing letter to referrer A letter should be sent to the referrer after therapy has ended and should include: • Reasons and date of original referral. • Number of meetings held • Who attended the meetings • The family’s concerns • Systemic Formulation/Understanding of Difficulties • Themes covered in meetings • Utility of therapy for the family • Evaluation of current state • Future plans • Copies to other agencies involved, with family’s permission Dear Dr Jones Re:

Smith family -

11 James Avenue, Leeds, LS2.

You will remember you referred the Smith family for family therapy in March 1998, for help with bereavement issues. The family attended for 5 appointments. We saw them last in November 1998 and a further appointment for December was cancelled. All members of the family attended meetings following an initial meeting with Mr & Mrs Smith alone. The parents outlined to us their concerns that their 2 children Jodie (6years) & John (9years), were expressing no grief relating to the death of their elder sister Julie, who died in a car crash in September 1997. Mr & Mrs Smith were concerned about how the loss was affecting them in both their achievement and behaviour at school, and expressed a wish that they were more able to talk about the issue as a family. Our 5 meetings were spent looking at the effect Julie’s death had had on both the parents and the children, and the stories they had developed for understanding what had happened. At the family’s request we also invited the Headmistress of the children’s school, Mrs Small, to look at ways the children could express their grief about Julie’s death within the school setting. In addition we thought about ways they might be supported to develop their concentration, when distracted or upset at school. The family used all of the meetings to their fullest, and communication concerning the bereavement improved very rapidly. The children also reported feeling happier at school. We had planned to continue, but the family phoned and left a message to say they felt things had improved at home and at school and they would contact us again if the need arose. We left it with them that we would be very happy to see them again if requested. Yours sincerely Dr Peter Stratton Family Therapist On behalf of The Leeds Family Therapy Team c.c. Mrs Small, Headmistress, Jacob school

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Appendix VI : Session Notes Record Form SYSTEMIC FAMILY THERPY MANUAL SESSION NOTES

Record Sheet Date of Session

Session

Number

Who attended therapy?

Therapist name Team member names Main themes of the session

Include key language used by family

Main themes continued

Team observations

Clearly labelled as impressions

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Interventions

Interventions continued

Key points/ideas/decisions to follow up in later sessions 1.

Proscribed Practices included in session Justification

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BASIC FAMILY THERAPY TECHNIQUES IN ALPHABETICAL ORDER

Basic Techniques in Family Counselling and Therapy

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BASIC FAMILY THERAPY TECHNIQUES IN ALPHABETICAL ORDER Basic Techniques in Family Counselling and Therapy • ACCOMMODATION The therapist makes personal adjustments in order to achieve a therapeutic alliance. Accommodating is: adapting to a family's communication style.

• ADVICE & INFORMATION These are derived from experience and knowledge of the family in therapy. They are used to calm down anxious members of families or reassure these individuals and families about certain actions.

• AFFECTIVE CONFRONTATION Affective Confrontation of Rigid Patterns and Roles is used to interrupt rigid pattrns. The goals may be a/ to raise clients' awareness when they do not know how they are contributing to the problem. b/ to raise a taboo subject that the client and others have been avoiding, or c/ to increase motivation to make changes when there is cognitivie awareness but no change in action. Examples: "When did you divorce your husband and marry your son?" "You are aware that you have abandoned the family to advance your career?" "What do you think would be more detrimental for your daughter: missing dance practice once a week for a few months or having her parents divorce? Do you want to ask your child what her preference is?"

• ASKING PERMISSION Narrative therapists use permission questions to emphasize the democratic nature of the therapeutic relationship and to encourage clients to maintain a clear, strong sense of agency when talking with the therapist. Asking permission to ask a question goes against the prevailing assumption that therapists can ask any question they want tot gather information they purportedly need to help the client. Many clients feel compelled to answer these questions, even if they are not comfortable doings so. Narrative therapists show their sensitivity by asking permission before asking questions that are generally taboo or concern difficult objects. Example: "Would it be okay if I ask you some questions about your sex life?" In addition, throughout the interview, the therapist may ask for client input and permission to continue with a particular topic or line of questioning.

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• BEGINNER’S MIND "In the beginner's mind there are many possibilities, in the expert's mind there are few" Position of curiosity. Viewing experiences as though for the first time. A beginner's mind is very open, very alert. It is not filled with ideas and notions, truths and dogmas. It is receptive.

• BOUNDARY FORMATION Part of the therapeutic task is to help the family define, or change the boundaries within the family. The therapist also helps the family to either strengthen or loosen boundaries, depending upon the family’s situation.

• ADDING COGNITIVE CONSTRUCTIONS Advice & Information are derived from experience and knowledge of the family in therapy. They are used to calm down anxious members of families or reassure these individuals and families about certain actions. Pragmatic fictions are formal expressions of opinion to help families and their members change. Paradox is an apparently sound argument leading to a contradiction. It is used to motivate family members to search or alternatives. Family members may defy the therapists and become better or they may explore reasons why their behaviours are as they are and make changes in the ways members interact.

• COMMUNICATION TECHNIQUES MATCHING THE CLIENT’S LANGUAGE Example: Use the exact words the client uses to describe the problem in asking questions about what they have done before, when it is not so serious a problem, etc. Also, attend to client’s metaphors and utilize them also to extend observations, learn about their interests or hobbies to use metaphors that involve them. MATCHING SENSORY MODALITIES Use words pertaining to “seeing” or “hearing” how things are and use words in the same vein. CHANNELING THE CLIENT’S LANGUAGE Channel away from jargon into action descriptions used in every day language. This has the effect of depathologizing or normalizing clients’ situations. Gradually change your terminology to less serious, more positive words. (Example: Use the words “transitional period” as this give the client the opportunity to take solace in hearing that a problem is temporary, helps shape their expectations for the future). USE OF VERB FORMS Create a reality where the problem is in the past and possibilities exist for the present and in the future. “When you had this problem before, you used to . . you were having difficulty . . how did the old you . . .” Help clients make distinctions that are helpful (feeling like or thinking about . . . rather than doing it).

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GIVE CLOSE EXAMINATION TO THEIR LANGUAGE AND YOURS. A.

Vague statements

Unspecified verbs :

“He ruined the relationship” (how, what way?). “I am scared” (of what)

Specify comparison:

“He is lazy” (compared to whom)

Empty nouns:

respect, love, anger, depression

Generalization:

all, none, always, never

Cannot/will not vs. doesn’t /did not

Characterizations

lazy, aggressive

Challenge claims:

“How do you know you feel depressed”

• COMMUNICATION SKILL-BUILDING TECHNIQUES More often than not, it's a family's communication patterns and styles that lead to conflict and division. Communication patterns and processes are often major factors in preventing healthy family functioning. Faulty communication methods and systems are readily observed within one or two family sessions. A variety of techniques can be implemented to focus directly on communication skill building between a couple or between family members. Communication techniques are used to build skills that allow for effective communication between family members.Listening techniques including restatement of content, reflection of feelings, taking turns expressing feelings, and nonjudgmental brainstorming are some of the methods utilized in communication skill building. REFLECTING involves having a member express her feelings and concerns, then having another member repeat back what he heard that person say. REPEATING techniques involves having a member state how he feels, while another member repeats back what was said. Repeating and reflecting techniques allow members to better understand where the other is coming from and why she feels as she does. FAIR FIGHTING TECHNIQUES focus on attentive listening and expressing feelings and concerns in a nonthreatening manner.

• CONCLUSION The techniques suggested here are examples from those that family therapists practice. Counsellors will customize them according to presenting problems. With the focus on healthy family functioning, therapists cannot allow themselves to be limited to a prescribed operational procedure, a rigid set of techniques or set of hypotheses. Therefore, creative judgment and personalization of application are encouraged.

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•

CONFIRMATION OF A FAMILY MEMBER:

Using an affective word to reflect an expressed or unexpressed feeling of that family member. The therapist can join families from different positions of proximity. In the close position of proximity, he can affiliate with family members, perhaps even entering into coalition with some members against others. Probably the most useful tool of affiliation is confirmation. The therapist validates the reality of the family member(s) he joins. He searches out positives and makes a point of recognizing and awarding hem.

• DETRIANGULATION The process by which an individual removes himself or herself from the motional field of two others. (triangulation is: Detouring conflict between two people by involving a third person, stabilizing the relationship between the original pair.)

• DIAGNOSING Diagnosing is done early in the therapeutic process. The goal is to describe the systematic interrelationships of all family members to see what needs to be changed or modified for the family to improve. By diagnosing interactions, therapists become proactive, instead of reactive.

• DIFFERENTIATION OF SELF Psychological separation of intellect and emotions and independence of self from others; opposite of fusion. (Fusion is a blurring of psychological boundaries between self and others and a contamination of emotional and intellectual functioning; opposite of differentiation.)

• DISEQUILIBRIUM TECHNIQUES The following techniques are used to create a different perception of reality. REFRAMING: The technique of reframing is a process in which a perception is changed by explaining a situation in terms of a different context. For example, the therapist can reframe a disruptive behaviour as being naughty instead of incorrigible allowing family members to modify their attitudes toward the individual and even help him or her makes changes. PUNCTUATION: Punctuation is “the selective description of a transaction in accordance with a therapist’s goals”. Therefore it is verbalizing appropriate behaviour when it happens. UNBALANCING: This is a procedure wherein the therapist supports an individual or subsystem against the rest of the family. When this technique is used to support an underdog in the family system, a chance for change within the total hierarchical relationship is fostered.

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• EMOTIONAL CUT-OFF Bowen's term for flight from an unresolved emotional attachment

• THE EMPTY CHAIR The empty chair technique, most often utilized by Gestalt therapists (Perls, Hefferline, & Goodman, 1985), has been adapted to family therapy. In one scenario, a partner may express his or her feelings to a spouse (empty chair), then play the role of the spouse and carry on a dialogue. Expressions to absent family, parents, and children can be arranged through utilizing this technique.

• ENACTMENT The process of enactment consists of families bringing problematic behavioural sequences into treatment by showing them to the therapist a demonstrative transaction. This method is to help family members to gain control over behaviours they insist are beyond their control. The result is that family members experience their own transactions with heightened awareness. In examining their roles, members often adapt new, more functional ways of acting.

• FAMILY CHOREOGRAPHY In family choreography, arrangements go beyond initial sculpting; family members are asked to position themselves as to how they see the family and then to show how they would like the family situation to be. Family members may be asked to reenact a family scene and possibly resculpt it to a preferred scenario. This technique can help a stuck family and create a lively situation

• FAMILY COUNCIL MEETINGS Family council meetings are organized to provide specific times for the family to meet and share with one another. The therapist might prescribe council meetings as homework, in which case a time is set and rules are outlined. The council should encompass the entire family, and any absent members would have to abide by decisions. The agenda may include any concerns of the family. Attacking others during this time is not acceptable. Family council meetings help provide structure for the family, encourage full family participation, and facilitate communication.

• FAMILY FLOOR PLAN The family floor plan technique has several variations. Parents might be asked to draw the family floor plan for the family of origin. Information across generations is therefore gathered in a nonthreatening manner. Points of discussion bring out meaningful issues related to one's past. Another adaptation of this technique is to have members draw the floor plan for their nuclear family. The importance of space and territory is often inferred as a result of the family floor plan. Levels of comfort between family members, space accommodations, and rules are often revealed. Indications of differentiation, operating family triangles, and subsystems often become evident. Used early in therapy, this technique can serve as an excellent diagnostic tool (Coppersmith, 1980).

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• FAMILY LIFE CYCLE Stages of family life from separation from one's parents to marriage, laving children, growing older, retirement, and, finally, death. Jjust like an individual, a family has developmental tasks and key (second-order) transitions like leaving home, joining of families through marriage, families with young children (the key milestone, and one that initiates vertical realignment), families with adolescents, launching children and moving on, families in later life. Key question: "How well did the family do on its last assignment?" Horizontal stressors are those involving these transitional assignments; vertical stressors are transmitted mainly via multigenerational triangling. Symptoms tend to occur when horizontal and vertical stressors intersect. Divorce adds extra developmental steps for all involved families.

Carter and mcgoldrick elaborated the family life cycle a. Leaving home b. Joining of families through marriage c. Families with young children d. Adolescence e. Launching children and moving on f. Families in later life

• FAMILY PHOTOS The family photos technique has the potential to provide a wealth of information about past and present functioning. One use of family photos is to go through the family album together. Verbal and nonverbal responses to pictures and events are often quite revealing. Adaptations of this method include asking members to bring in significant family photos and discuss reasons for bringing them, and locating pictures that represent past generations. Through discussion of photos, the therapist often more clearly sees family relationships, rituals, structure, roles, and communication patterns.

• FAMILY SCULPTING Developed by Duhl, Kantor, and Duhl (1973), family sculpting provides for recreation of the family system, representing family members relationships to one another at a specific period of time. The family therapist can use sculpting at any time in therapy by asking family members to physically arrange the family. Adolescents often make good family sculptors as they are provided with a chance to nonverbally communicate thoughts and feelings about the family. Family sculpting is a sound diagnostic tool and provides the opportunity for future therapeutic interventions. An activity in which family members place themselves in postures symbolic of the family dynamics. Satir placed people in position herself to activate right-brain experiencing.

• FAMILY SYSTEM STRATEGIES A family operates like a system in that each member's role contributes to the patterns of behaviour that make the system what it is. Certain therapy techniques are designed to reveal the patterns that make a family function the way it does. The tracking technique is a recording process where the therapist keeps notes on how situations develop within the family system. Interventions used to address family problems can be designed based on the patterns uncovered by this technique. Family sculpting is another technique that's used to realign relationship patterns within the group. Members are asked to physically arrange where they want each member to be in relation to the others. This technique provides insight into relationship conflicts within the family.

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• FRAMING QUESTIONS Questions asked can elicit information about strengths, abilities, and resources. Perceptions of problems then change significantly in this context. 1. THE MIRACLE QUESTION: Suppose that one night, while you were asleep, there was a miracle and this problem was solved. How would you know? What would be different? This type of question seems to make a problem-free future more real and therefore more likely to occur. The therapist gives guidelines and information to help the client go directly to a more satisfactory future. 2. FAST-FORWARDING QUESTIONS can be used when clients can’t identify exceptions or past solutions. Clients are asked to envision a future without the problem and describe what that looks like. (The miracle question or a magic wand question). => “What will not would be different?” 3. THE EXCEPTION QUESTION: Asks the client to focus on times when problem does not occur or has not occurred when they expected it would. They may discover solutions they had forgotten or not noticed. The therapist might find clues on which to build future solutions. Example: “What is different about those times when things are working?”

• THE GENOGRAM One of the best ways to begin therapy and to gain understanding of how the emotional system operates in your family system is to put together your family genogram. Studying your own patterns of behaviour, and how they relate to those of your multigenerational family, reveals new and more effective options for solving problems and for changing your response to the automatic role you are expected to play. The genogram, a technique often used early in family therapy, provides a graphic picture of the family history. The genogram reveals the family's basic structure and demographics. (McGoldrick & Gerson, 1985). Through symbols, it offers a picture of three generations. Names, dates of marriage, divorce, death, and other relevant facts are included in the genogram. It provides an enormous amount of data and insight for the therapist and family members early in therapy. As an informational and diagnostic tool, the genogram is developed by the therapist in conjunction with the family.

• GOAL SETTING Start small — “What will be the first sign that things are moving in the right direction?” Goals must be concrete.

• IDENTIFICATION Family therapy techniques are used with individuals and families to address the issues that effect the health of the family system. The techniques used will depend on what issues are causing the most problems for a family and on how well the family has learned to handle these issues. Strategic techniques are designed for specific purposes within the treatment process. Background information, family structuring and communication patterns are some of the areas addressed through these methods.

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• INFORMATION-GATHERING TECHNIQUES At the start of therapy, information regarding the family's background and relationship dynamics is needed to identify potential issues and problems. • •

•

The genogram is a technique used to create a family history, or geneology. Both the family and therapist work to create this diagram. Having family members bring in meaningful family photos is also a technique used to gather information as to how each member perceives the others. One other technique involves having family members draw up floor plans of their home. This exercise provides information on territorial issues, rules, and comfort zones between different members.

• INTENSITY Intensity is the structural method of changing maladaptive transactions by using strong affect, repeated intervention, or prolonged pressure. Intensity works best if done in a direct, unapologetic manner that is goal specific.

• INTERVENTION TECHNIQUES Intervention techniques are directives given by the therapist to guide a family's interactions towards more productive outcomes. Reframing is a method used to recast a particular conflict or situation in a less threatening light. A father who constantly pressures his son regarding his grades may be seen as a threatening figure by the son. Reframing this conflict would involve focusing on the father's concern for his son's future and helping the son to "hear" his father's concern instead of constant demands for improvement. Another technique has the therapist placing a particular conflict or situation under the family's control. What this means is, instead of a problem controlling how the family acts, the family controls how the problem is handled. This requires the therapist to give specific directives as to how long members are to discuss the problem, who they discuss it with, and how long these discussions should last. As members carry out these directives, they begin to develop a sense of control over the problem, which helps them to better deal with it effectively.

• JOINING This is the process of coupling that occurs between the therapist and the family, leading to the development of therapeutic system. In this process the therapist allies with family members by expressing interest in understanding them as individuals and working with and for them. Joining is considered one of the most important prerequisites to restructuring. It is a contextual process that is continuous. There are four ways of joining in structural family therapy. •

Tracking: In tracking, the therapist follows the content of the family that is the facts. Getting information through using open-ended questions. Tracking is best exemplified when the therapist gives a family feedback on what he or she has observed or heard.

•

Mimesis: The therapist becomes like the family in the manner or content of their communications.

•

Confirmation of a family member: Using an affective word to reflect an expressed or unexpressed feeling of that family member.

•

Accommodation: The therapist makes personal adjustments in order to achieve a therapeutic alliance.

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• PARADOXICAL INJUNCTIONS A paradox is an apparently sound argument which leads to a contradiction. It is used to motivate family members to search or alternatives. Family members may defy the therapists and become better or they may explore reasons why their behaviours are as they are and make changes in the ways members interact.

• PRAGMATIC FICTIONS Formal expressions of opinion to help families and their members change.

• PRESCRIBING INDECISION The stress level of couples and families often is exacerbated by a faulty decision-making process. Decisions not made in these cases become problematic in themselves. When straightforward interventions fail, paradoxical interventions often can produce change or relieve symptoms of stress. Such is the case with prescribing indecision. The indecisive behaviour is reframed as an example of caring or taking appropriate time on important matters affecting the family. A directive is given to not rush into anything or make hasty decisions. The couple is to follow this directive to the letter.

• PROBLEM SOLVING TECHNIQUES 1. Dissolve the idea that there is a problem: Help people see their situations in new ways. 2. Negotiate a solvable problem: Reduce the size of the problem in the client’s eyes. (Get specific about the problem; focus on when it is not so serious a problem). 3. Frame towards the idea that clients have all the abilities and resources to solve the problem: Create an atmosphere that facilitates the realization of strengths and abilities.

• PUNCTUATION Punctuation is “the selective description of a transaction in accordance with a therapist’s goals”. Therefore it is verbalizing appropriate behaviour when it happens. Punctuation: thinking that you cause what I say.

• PUTTING CLIENT IN CONTROL OF THE SYMPTOM This technique, widely used by strategic family therapists, attempts to place control in the hands of the individual or system. The therapist may recommend, for example, the continuation of a symptom such as anxiety or worry. Specific directives are given as to when, where, and with whom, and for what amount of time one should do these things. As the client follows this paradoxical directive, a sense of control over the symptom often develops, resulting in subsequent change.

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• REFRAMING Most family therapists use reframing as a method to both join with the family and offer a different perspective on presenting problems. Specifically, reframing involves taking something out of its logical class and placing it in another category (Sherman & Fredman, 1986). For example, a mother's repeated questioning of her daughter's behaviour after a date can be seen as genuine caring and concern rather than that of a nontrusting parent. Through reframing, a negative often can be reframed into a positive. The technique of reframing is a process in which a perception is changed by explaining a situation in terms of a different context. For example, the therapist can reframe a disruptive behaviour as being naughty instead of incorrigible allowing family members to modify their attitudes toward the individual and even help him or her makes changes.

• REFRAMING PROBLEM DEFINITIONS Solution Oriented therapists offer new, more workable problem definitions that are within the power of the client and therapist to solve. They usually help the client reframe the problem definition to a more positive one or listen for a hint of something in the client’s complaint that can be solved. This co-creates the experience that the problem is solvable and the client has some ability to solve it.

• RESTRUCTURING The procedure of restructuring is at the heart of the structural approach. The goal is to make the family more functional by altering the existing hierarchy and interaction patterns so that problems are not maintained. It is accomplished through the use of enactment, unbalancing, and boundary formation.

• SHAPING COMPETENCE The family therapists help families and individuals in becoming more functional by highlighting positive behaviours.

• SPECIAL DAYS, MINI-VACATIONS, SPECIAL OUTINGS Couples and families that are stuck frequently exhibit predictable behaviour cycles. Boredom is present, and family members take little time with each other. In such cases, family members feel unappreciated and taken for granted. "Caring Days" can be set aside when couples are asked to show caring for each other. Specific times for caring can be arranged with certain actions in mind (Stuart, 1980).

• STRATEGIC ALLIANCES This technique, often used by strategic family therapists, involves meeting with one member of the family as a supportive means of helping that person change. Individual change is expected to affect the entire family system. The individual is often asked to behave or respond in a different manner. This technique attempts to disrupt a circular system or behaviour pattern.

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• TRACKING The tracking technique is a recording process where the therapist keeps notes on how situations develop within the family system. Interventions used to address family problems can be designed based on the patterns uncovered by this technique Most family therapists use tracking. Structural family therapists (Minuchin & Fishman, 1981) see tracking as an essential part of the therapist's joining process with the family. During the tracking process the therapist listens intently to family stories and carefully records events and their sequence. Through tracking, the family therapist is able to identify the sequence of events operating in a system to keep it the way it is. What happens between point A and point B or C to create D can be helpful when designing interventions. In tracking, the therapist follows the content of the family that is the facts. Getting information through using openended questions. Tracking is best exemplified when the therapist gives a family feedback on what he or she has observed or heard.

• UNBALANCING This is a procedure wherein the therapist supports an individual or subsystem against the rest of the family. When this technique is used to support an underdog in the family system, a chance for change within the total hierarchical relationship is fostered.

• INTRODUCING UNCERTAINTY The therapist can introduce some uncertainty into the problem definition by asking “What gives you the impression that things seem difficult to handle?” Or he/she can imply that there are days when the problem is nonexistent by asking “What is different about the days when things seem manageable?”

• WORKING WITH SPONTANEOUS INTERACTION In addition to enactment, structural family therapists concentrate on spontaneous behaviours in sessions. It occurs whenever families display behaviours in sessions that are disruptive or dysfunctional, such as members yelling at one another or parents withdrawing from their children. The focus is on process not content. It is important that therapists help families recognize patterns of interaction and what changes they might make to bring about modification.

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Summary of Family Therapy Theories & Techniques Theoretical Model

Adlerian Family Therapy

Attachment Theory

Theorists

Summary

Techniques

Alfred Adler

Also known as "Individual Psychology". Sees the person as a whole. Ideas include compensation for feelings of inferiority leading to striving for Psychoanalysis, Typical Day, Reorienting, Resignificance toward a fictional final goal with a private logic. Birth order and mistaken goals are educating explored to examine mistaken motivations of children and adults in the family constellation.

John Bowlby, Mary Ainsworth

Individuals are shaped by their experiences with caregivers in the first three years of life. Used as a foundation for Object Relations Theory. The Psychoanalysis, Play Strange Situation experiment with infants involves Therapy a systematic process of leaving a child alone in a room in order to assess the quality of their parental bond.

Also known as “Intergenerational Family Therapy” (although there are also other schools of Murray Bowen, Betty intergenerational family therapy). Family members Carter, Philip Guerin, are driven to achieve a balance of internal and Michael Kerr, Thomas Detriangulation, external differentiation, causing anxiety, Bowenian Family Nonanxious Presence, Fogarty, Monica Systems triangulation, and emotional cutoff. Families are Genograms, Coaching McGoldrick, Edwin affected by nuclear family emotional processes, Friedman, Daniel sibling positions and multigenerational Papero transmission patterns resulting in an undifferentiated family ego mass.

Cognitive Behavioural Family Therapy

John Gottman, Albert Ellis, Albert Bandura

Problems are the result of operant conditioning that reinforces negative behaviours within the family’s interpersonal social exchanges that extinguish desired behaviour and promote incentives toward unwanted behaviours. This can lead to irrational beliefs and a faulty family schema.

Therapeutic Contracts, Modeling, Systematic Desensitization, Shaping, Charting, Examining Irrational Beliefs

Individuals form meanings about their experiences within the context of social relationship on a personal and organizational level. Collaborative therapists help families reorganize and dis-solve Harry Goolishian, their perceived problems through a transparent Collaborative Harlene Anderson, Tom dialogue about inner thoughts with a “notLanguage Systems Andersen, Lynn knowing” stance intended to illicit new meaning Hoffman, Peggy Penn through conversation. Collaborative therapy is an approach that avoids a particular theoretical perspective in favor of a client-centered philosophical process.

Dialogical Conversation, Not Knowing, Curiosity, Being Public, Reflecting Teams

Communications

Equality, Modeling

Virginia Satir, John

All people are born into a primary survival triad

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Approaches

Contextual Therapy

Banmen, Jane Gerber, Maria Gomori

Ivan BöszörményiNagy

Emotion-Focused Sue Johnson, Les Therapy Greenberg

between themselves and their parents where they adopt survival stances to protect their self-worth from threats communicated by words and behaviours of their family members. Experiential therapists are interested in altering the overt and covert messages between family members that affect their body, mind and feelings in order to promote congruence and to validate each person’s inherent self-worth.

Communication, Family Life Chronology, Family Sculpting, Metaphors, Family Reconstruction

Families are built upon an unconscious network of implicit loyalties between parents and children that Rebalancing, Family can be damaged when these “relational ethics” of Negotiations, Validation, fairness, trust, entitlement, mutuality and merit are Filial Debt Repayment breached. Couples and families can develop rigid patterns of interaction based on powerful emotional Reflecting, Validation, experiences that hinder emotional engagement and Heightening, Reframing, trust. Treatment aims to enhance empathic Restructuring capabilities of family members by exploring deepseated habits and modifying emotional cues.

Carl Whitaker, David Kieth, Laura Roberto, Walter Kempler, John Warkentin, Thomas Malone, August Napier

Stemming from Gestalt foundations, change and growth occurs through an existential encounter with a therapist who is intentionally “real” and authentic with clients without pretense, often in a playful and sometimes absurd way as a means to foster flexibility in the family and promote individuation.

Feminist Family Therapy

Sandra Bern,

Complications from social and political disparity between genders are identified as underlying causes of conflict within a family system. Demystifying, Modeling, Therapists are encouraged to be aware of these Equality, Personal influences in order to avoid perpetuating hidden Accountability oppression, biases and cultural stereotypes and to model an egalitarian perspective of healthy family relationships.

Milan Systemic Family Therapy

A practical attempt by the “Milan Group” to establish therapeutic techniques based on Gregory Luigi Boscolo, Bateson’s cybernetics that disrupts unseen Hypothesizing, Circular Gianfranco Cecchin, systemic patterns of control and games between Questioning, Neutrality, Mara Selvini Palazzoli, family members by challenging erroneous family Counterparadox Giuliana Prata beliefs and reworking the family’s linguistic assumptions.

Medical Family Therapy[39]

Goerge Engel, Susan McDaniel, Jeri Hepworth & William Doherty

Experiential Family Therapy

Families facing the challenges of major illness experience a unique set of biological, psychological and social difficulties that require a specialized skills of a therapist who understands the complexities of the medical system, as well as the full spectrum of mental health theories and

Battling, Constructive Anxiety, Redefining Symptoms, Affective Confrontation, CoTherapy, Humor

Grief Work, Family Meetings, Consultations, Collaborative Approaches

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techniques.

MRI Brief Therapy

Established by the Mental Research Institute (MRI) as a synthesis of ideas from multiple Gregory Bateson, theorists in order to interrupt misguided attempts Milton Erickson, Heinz by families to create first and second order change von Foerster by persisting with “more of the same,” mixed signals from unclear metacommunication and paradoxical double-bind messages.

Michael White, David Narrative Therapy Epston

Object Relations Therapy

Psychoanalytic Family Therapy

Individuals choose relationships that attempt to Hazan & Shaver, David heal insecure attachments from childhood. Scharff & Jill Scharff, Negative patterns established by their parents James Framo, (object) are projected onto their partners.

Nathan Ackerman

Kim Insoo Berg, Steve de Shazer, William Solution Focused O'Hanlon, Michelle Therapy Weiner-Davis, Paul Watzlawick

Strategic Therapy

People use stories to make sense of their experience and to establish their identity as a social and political constructs based on local knowledge. Narrative therapists avoid marginalizing their clients by positioning themselves as a co-editor of their reality with the idea that “the person is not the problem, but the problem is the problem.”

Jay Haley, Cloe Madanes

Salvador Minuchin, Harry Aponte, Charles Structural Therapy Fishman, Braulio Montalvo

Reframing, Prescribing the Symptom, Relabeling, Restraining (Going Slow), Bellac Ploy

Deconstruction, Externalizing Problems, Mapping, Asking Permission

Detriangulation, CoTherapy, Psychoanalysis, Holding Environment

By applying the strategies of Freudian psychoanalysis to the family system therapists can Psychoanalysis, gain insight into the interlocking Authenticity, Joining, psychopathologies of the family members and seek Confrontation to improve complementarity The inevitable onset of constant change leads to negative interpretations of the past and language Future Focus, Beginner’s that shapes the meaning of an individual’s Mind, Miracle Question, situation, diminishing their hope and causing them Goal Setting, Scaling to overlook their own strengths and resources. Directives, Paradoxical Symptoms of dysfunction are purposeful in Injunctions, Positioning, maintaining homeostasis in the family hierarchy as Metaphoric Tasks, it transitions through various stages in the family Restraining (Going life cycle. Slow) Joining, Family Family problems arise from maladaptive Mapping, boundaries and subsystems that are created within Hypothesizing, the overall family system of rules and rituals that Reenactments, governs their interactions. Reframing, Unbalancing

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Family Therapy Survey Nichols and Schwartz (1998)

I. The Foundations of Family Therapy - Outline by David Peers A. The myth of the hero 1. The individual is unique and autonomous 2. Breaking free from childhood 3. The myth of rising above the human condition and individuation 4. Individuals are sustained by interpersonal relationships 5. Families are both withholding and uplifting - sometimes at the same time B. Psychotherapeutic sanctuary 1. Therapy in isolation or in groups? 2. Freud and Rogers emphasized private patient/therapist relations 3. Freud: real family who needs it? The use of transference - the therapist as parent 4. Rogers: exploration of self and self - actualization. The need for approval 5. Rogers: support, unconditional positive regard, and the art of listening C. Family vs. Individual therapy 1. Both are approaches to treatment and understandings of human behavior 2. Individual therapy a. Concentrated focus b. Internalization of personal dynamics 3. Family therapy a. External focus b. Changing organizations - change on the entire family, systemic 4. Are we separate entities or embedded in a network of relationships? D. Psychology and social context 1. Family therapy flourishes because of success and recognition of interconnectedness 2. Is psychotherapy intrapsychic or interpersonal? Perhaps both or neither? 3. Family therapy as an orientation rather than a technique 4. Uncovering family influences 5. Individuals within a system

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E. The power of family therapy 1. Evolution from 1950’s to today 2.1975 - 1985 as golden age - shared optimism and common purpose 3. Problems may originate from interaction so change focuses on interactions 4. Questions: a. Constructivist notions? b. Narrative therapy? c. Integrative techniques? d. Social issues? F. Contemporary cultural influences 1. Managed health care a. Crisis intervention versus ongoing personal exploration? b. Confidentiality?. Prejudicial employers? 2. Postmodern skepticism a. Integrated schools of thought b. Approaches to clients or clients to approaches? G. Thinking in lines vs. Thinking in circles 1. Cause and effect perspectives - unilateral influence 2. Circles of thought as empowering 3. Transforming interactions 4. Major advantage of family therapy: works directly on unhappy relationships 5. The difficulty of change 6. Personal participation in problems 7. Circular problems - the cause is the result and the result the cause 8. Learning life’s painful lessons and understanding the family’s story

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II. The Evolution Of Family Therapy - Outline by Lori Rice A. The undeclared war 1. 1950’s - - change in one person changes the system 2. Brown research with schizophrenic patients returning home (1959) 3. Current psychiatric hospital therapy and possible family segregation B. Small group dynamics 1. William Mcdougall - group mind 2. Lewin - group is more than the sum of its parts - - group discussions superior to individual instruction for changing ideas/behavior 3. Bion (1948) fight - flight, dependency, and pairing 4. Process/content in group dynamics 5. Role theories 6. Similarities between group and family therapies C. Child guidance movement 1. Scholars publishing more than clinicians 2. Movement assumption: Emotional problems begin in childhood, therefore treat the child 3. Shift to include families in treatment, but typically blame parents for child’s problems Fromm Reichmann’s schizophrenogenic mother D. The influence of social work 1. Family casework - families must be considered as units 2. Social workers among most influential in family therapy E. Research on family dynamics and the etiology of schizophrenia 1. Gregory Bateson a. Researched communication among animals b. Functions of communication: report and command, metacommunication c. Bateson joined by others to investigate conflicts between messages and qualifying messages d. Double bind 2. Theodore Lidz 3. Lyman Wynne - rubber fences, pseudomutuality, and pseudohostility 4. Role theorists marriage counseling

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III. Early Models And Basic Techniques: Group Process And Communications Analysis Outline by Sarah Sifers. A. Family therapy has a history of being condescending B. Sketches of leading figures 1. Group family therapy (group) - Bell, Dreikurs, Midelfort, Foulkes, Skynner 2. Communications family therapy (communication) - Jackson, Haley, Bateson, Satir C. Theoretical formulations - group 1. Group/family leaders 2. Family defense mechanisms 3. Subgroups 4. Field theory (Lewin) - conflict is an â&#x20AC;&#x2DC;inevitable part of group life 5.Role theory - every group has roles that have "rules" for conduct (intra - and inter - role conflict, fit between personality and role) D. Theoretical formulations - communications 1. Black box - disregards individual complexity to focus on input and output (communication) 2. Circular causal (disregard past) 3. Syntax - - ways words are put together to make sentences 4. Semantics - clarity, private or shared communication systems, concordance versus confusion 5. Pragmatics - behavioral effects of communication 6. People are always communicating 7. Re ort - (content) conveys information 8. Command - statement about the definition of the relationship 9. Family rules - description of regular interactions 10. Family homeostasis - acceptable behavioral balance within the family 11. Complementary relationships - based on differences that fit together 12. Symmetrical relationships - based on equality and mirroring of behavior 13. Communication punctuation - organizes behavioral events and reflects observer bias 14. Negative feedback loop - perpetuates problems by maintaining status quo 15. Positive feedback loop - alters the system to accommodate novel input

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E. Normal family development 1. Group a. Instrumental and expressive leaders b. Three phases of group development: inclusion, control, affection c. Cohesiveness d. Need compatibility 2. Communications a. Feedback loops b. Normal families become unbalanced during transitions in family life cycle F. Development of behavior disorders 1. Group - symptoms as products of disturbed and disturbing group processes - if needs continue to go unmet, symptoms may be perpetuated into a role and group organizes around a "sick" member 2. Communications - "identified patient" as a role with counterroles and complimentary roles that maintain the system - - - caused by pathological communication such as paradoxical injunctions/ double binds G. Goals of therapy 1. Group - individuation of group members, personal growth, and improved relationships 2. Communications - change/prevent maladaptive interactions viii. H. Conditions for behavior chang 1. Group - help family members talk to each other, concentrating more on process than content, then explore those feelings 2. Communications - making covert messages behind symptoms overt. Therapist may manipulate the family be prescribing the symptom or therapeutic double binds, introducing positive feedback loops I. Techniques of group family therapy 1. Therapist as process leader 2. Stages - child - centered, parent - centered, family - centered 3. Types of therapy - multiple group therapy, multiple impact therapy, network therapy 4. Resistance - anything that interfered with balanced self - expression J. Techniques of communications family therapy 1. Structured family interview (5 tasks) 2. Teaching rules of clear communication - (using "I", stating facts, talking to - not about) 3. Used familyâ&#x20AC;&#x2122;s moment to circumvent resistance 4. Therapist as referee and reframer, making implicit rules explicit and using therapeutic paradox

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K. Lessons from early models 1. Group - group dynamics, roles, process/content distinction, free and open discussion, reflective interpretations, connective interpretations, reconstructive interpretations, normative interpretations, networking, confronting, caveat - families aren’t egalitarian 2. Communications - double bind, metacommunication, homeostasis, rules, feedback loops, cybernetics, altering patterns of communication, paradoxical directives, symptoms - focused, focus on marital pair L. System’s anxiety 1. Therapists viewed family as being to blame for a "victim’s" illness and were, therefore, the enemy 2. Cybernetics and general systems theory helped clinicians understand families, but tend to dismiss selfhood as an illusion M. Stages of family therapy (checklists in text) 1. Initial call - keep it short 2. First interview - build alliance and hypothesize 3. Early phase of treatment - refining hypothesis and beginning to work on problems 4. Middle phase of treatment - family begins to take more active role 5. Termination - review and consolidate N. Family assessment 1. Presenting problem 2. Understanding referral route 3. Identifying systemic context (interpersonal context of presenting concern) 4. Stages of life cycle 5. Family structure 6. Communication 7. Drug and alcohol abuse 8. Domestic violence and sexual abuse 9. Extramarital involvement (not just sexual affairs) 10. Gender (roles, expectations, and society) 11. Cultural factors (including mainstream) 12. Ethical dimension (therapist and family’s ethics) O. Working with managed care - it’s necessary, so cooperate

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IV. The Fundamental Concepts Of Family Therapy Outline by Anabella Pavon A. Conceptual influences on the evolution of family therapy 1. Opening thoughts a. Systems theory i. Consensus among family therapists about systems theory - most influential in development ii. Consensus among family therapists about systems theory - don’t really know how to explain it iii. Systems theory - abstract concept; way of thinking rather than established doctrine b. Many influences on family therapy i. Biology v. Community mental health ii. Physiology vi. Anthropology iii. Cybernetics vii. Social work iv. Psychosomatic medicine 2. Functionalism a. Reaction to evolutionary method of removing from context b. Anthropology - Malinowski and Brown - need to study in context c. Functionalist premise - "...the adaptive value of any activity can be found if the behavior is viewed in the context of the environment" (pg. 110) d. Evolutionary theory and psychoanalysis e. Bateson f. Functionalist influence on family therapy i. Deviant behaviors may be functional - (scapegoats) ii. Brass tacks - families are organisms adapting to environment in context - problems with family show problems with adjustment to environment iii. Problem - "us against them" 3. General systems theory - Bertalanffy - a misinterpretation a. All systems are subsystems b. What did family therapy forget? Larger systems c. Is it important for family therapists to consider values? 4. Cybernetics of families a. Weiner’s idea of self - correcting systems b. Feedback loop i. Negative feedback loop - reduces deviation or change ii. Positive feedback loop - amplifies deviation or change c. Cybernetics applications to families: family rules, neg. Feedback, sequences of interactions, positive feedback loops when neg. Feedback loops don’t work d. Metacommunicating - communicating about communicating e. Bateson - introduced concept to family therapy - movement from linear circular causality f. Split - Haley control and power vs. Bateson

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5. From cybernetics to structure a. Haley - coalitions b. Structural concept of families - subsystems with boundaries c. Basic premise - chance structural context, change individual d. Minuchin - cartographer of family structure 6. Satirâ&#x20AC;&#x2122;s humanizing effect - look at nurturance instead of control 7. Bowen and differentiation of self a. Undifferentiated family ego mass b. Differentiation of self c. Multigenerational transmission process 8. Family life cycle B. Enduring concepts and methods 1. Interconnectedness 2. Sequences of interaction a. Triangles b. Circular sequences c. Indirect communication 3. Family structure 4. Function of the symptom 5. Circumventing resistance 6. The nonpathological view of people 7. Family of origin 8. Focussing on solutions 9. Changing a familyâ&#x20AC;&#x2122;s narrative 10. The influence of culture

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V. Bowen Family Systems Therapy Outline by Jared Warren A. Sketches of leading figures 1. Murray Bowen 2. Philip Guerin 3. Thomas Fogarty 4. Betty Carter 5. Monica McGoldrick 6 Edwin Friedman 7. Michael Kerr 8. James Framo B. Theoretical formulations 1. Differentiation of self 2. Triangles 3. Nuclear family emotional process 4. Family projection process 5. Multigenerational transmission process 6. Sibling position 7. Emotional cutoff 8. Societal emotional process C. Normal family development 1. All families lie on continuum from emotional fusion to differentiation 2. Optimal family development: good differentiation, low anxiety, parents in good emotional contact with families of origin 3. Fogarty elaborates 12 characteristics of well - adjusted families in "systems concepts and the dimensions of selfâ&#x20AC;&#x2122; (1976) 4. Hallmark of well adjusted person is rational objectivity and individuality 5. Carter and mcgoldrick elaborated the family life cycle a. Leaving home b. Joining of families through marriage c. Families with young children d. Adolescence e. Launching children and moving on f. Families in later life 6. First - order change vs. Second - order change

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D. Development of behaviour disorders 1. Symptoms develop when level of anxiety exceeds system’s ability to cope 2. Most vulnerable individual is most likely to develop symptoms 3. Bowen’s primary approach: calm down the parents and coach them to deal more effectively with the problem 4. Guerin and fogarty put more emphasis on relationship with symptomatic child and nuclear family triangles 5. According to bowen, behavior disorders result from emotional fusion transmitted from one generation to the next E. Goals of therapy 1. Keys to therapy: process and structure 2. Primary goals: decrease anxiety and increase differentiation of self 3. Creation of new triangle in therapy between husband, wife, and emotionally neutral therapist 4. Goals for extended family: developing one - to - one relationships and avoiding triangles 5. Approaches of Guerin and McGoldrick F. Conditions for behavior change 1. Therapists must avoid taking sides and promoting triangulation, and avoid being reactive to inevitable emotionality in families 2. Change requires awareness of entire family 3. Development of personal relationship with everyone in family G. Techniques 1. Bowenian therapy with couples a. Use of displacement b. Therapist concentrates on process of couple’s interactions c. Use of the "i - position" d. Didactic teaching 2. Bowenian therapy with one person a. Goal of differentiation b. Genograms c. Identifying triangles, reentry into family of origin H. Evaluating therapy theory and results 1. Major shortcoming: can neglect importance of working directly with nuclear family 2. Evaluation has relied more on clinical reports than empirical data I. Summary - Seven prominent techniques 1. Genogram 2. The therapy triangle 3. Relationship experiments 4. Coaching 5. The "I-position" 6. Multiple family therapy 7. Displacement stories

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VI. Experiential Family Therapy Outline by Sarah Sifers A. Leading figures and background 1. Emerged in the 1960s from humanistic psychology and drew heavily from gestalt therapy and encounter groups (it is not very popular today) 2. Carl Whitaker 3. Virginia Satir (yes, the same one from communications family therapy) 4. Walter Kempler 5. Bunny and Fred Duhl 6. David Kantor 7. Current figures: Leslie Greenberg and Susan Johnson B. Theoretical formulations 1. Commitment to freedom, individuality, personal awareness, individualsâ&#x20AC;&#x2122; goals and values, self expression, and personal fulfillment, but largely atheoretical 2. There is a wide variety of perspectives that a rather loosely connected under the heading of experiential family therapy C. Normal family development a. Continuous growth and change and flexibility b. Nurtures and supports individual growth and experience (which leads to increased growth in the family) open (say anything) and constructive problem solving c. Natural and spontaneous; freedom, privacy, and togetherness D. Development of behavior disorders 1. Family and societal pressures prevent naturally occurring self - actualization 2. Denial of impulses and suppression of feelings (emotional deadness) 3. Seeking security and stability (rigid) rather than satisfaction 4. Loyalty to family stressed over loyalty to self 5. Mystification - smothering emotion and desire 6. Marriages consist of two people trying to work out conflicts that arise from each trying to reconstruct his or her family of origin and their differences frighten them causing them to cling closer together 7. Includes "normal" difficulties such as infidelity or "quiet desperation"and "invisible" (culturally accepted) symptoms such as overwork and smoking 8. Intrapsychic defenses that lead to interpersonal problems 9. Getting stuck during a life transition or change 10. Lack of warmth >>> avoidance >>> preoccupation with outside activities 11. "wrong" communication: blaming, placating, being irrelevant, and being super reasonable

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E. Goals of therapy 1. Find fulfilling roles for self that don’t override concern for the needs of the family as a whole (personal growth and family integration) 2. Increased self - awareness and expression that facilitates open family communication (you can’t communicate what you’re not aware of) 3. Growth, personal integrity, freedom of choice, less dependence, "expanded experience," increased sense of competence, self - esteem, and well - being 4. Openly acknowledge support, and make use of individual differences 5. Being spontaneous, "crazy" F. Conditions for behavior change 1. Evocative measures (resulting in anger, anxiety, etc.) To create therapeutic change by opening people up or discover hidden emotions 2. Therapist must be warm and supportive, become a family member, be a "real person" 3. Therapist teaches by example how to be open, honest, and spontaneous 4. Including as many family members as possible (3 generations and kids) 5. Therapist needs to be mature, experienced, and have a satisfying family life G. techniques 1. Clarifying communication (often through directives) 2. Focus on solutions rather than past grievances and point out positives 3. Support all family members’ self - esteem 4. Asking questions about emotions that are not expressed clearly (ind. Nonverbal cues) 5. Use of touch 6. Use of co - therapists to manage counter - transference 7. Very little formal assessment or history taking 8. Specific techniques (see book for description): family sculpture, family puppet interviews, family art therapy, conjoint family drawings, gestalt therapy techniques, symbolic drawing of family life space, role playing, there - and then techniques, "psychotherapy of the absurd" 9. Interrupting family dialogues to work with individuals H. Evaluation 1. No empirical studies, but some anecdotal support 2. Family therapists would benefit from being more honest and open with clients 3. Shifting the focus to an individual is a way to stop family bickering

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VII. Psychoanalytic Family Therapy Outline by Anabella Pavon A. Introduction 1. Many early family therapists have their roots in psychoanalytic training 2. Several psychodynamic therapists completely turned away from looking at the individual 3. 80s - family therapists looked at the individual again 4. Paradox: psychoanalysis is for the individual, family therapy the family. How can there be Psychoanalytic family therapy? B. Sketches of leading figures 1. Four groups of contributors to psychoanalytic family therapy - forerunners, psychoanalytically trained pioneers, psychoanalytic ideas and thoughts when the field turned from psychoanalytic ideas, and contemporary psychoanalytic family therapists 2. Adelaide Johnson - superego lacunae - gaps in personal morality passes on by parents 3. Erik Erikson - sociology and ego psychology 4. Wait ... Thereâ&#x20AC;&#x2122;s more - Erich Fromm predecessor of Bowen, Sullivan, Wynne, Lidz, Acherman strongest tie to psychoanalytic theory 5. Nathan Acherman - the psychodynamics of family life (1958) - first book dealing strictly with diagnosis and treatment of families 6. Ivan Boszormenyi - Nagy - center of family therapy at the eastern Pennsylvania Psychiatric Institute. 7. Dicks - worked with couples in England 8. John Bowlby C. Theoretical formulations 1. "Practical essence of psychoanalytic theory is being able to recognized and interpret Unconscious impulses and defenses against them .... 2. Freudian drive psychology - sexual and aggression 3. Self psychology - people want to be appreciated 4. Object relations theory - bridge between psychoanalysis and family therapy - relate to people in the present partially based on expectations we develop in early relationships D. Normal family development 1. Healthy psychological development based on good early environment - parents - good object relations 2. Lots of talk about the mother and early mother/child attachment 3. Separation/individuation - provision of reliable support from mother is necessary 4. Parents need to be empathetic and model idealization 5. Ivan Boszormenyi - Nagy - contextual therapy - concerned with the ethics of families "loyalty and trust provide the glue that holds families together"

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E. Development of behavior disorders 1. Where non - psychoanalytic family therapist look at problems in interactions between people while psychoanalytic therapists look at problems in the actual people in the family 2. Symptoms come from attempting to cope with unconscious conflicts and the Anxiety that signals the emergence of repressed impulses" 3. Some problems can occur with parents not accepting children’s separation 4. Kohut - mirroring and idealization - when these needs aren’t met from parents, go on to be showy and seek admiration 5. Fixation and regression in families - after marriage, people can go back to behaviors seen when they were younger 6. Nnagy - symptoms occur when trust breaks down in relationships - individuals feel the effects 7. Kernberg - blurred boundaries occur when connections are formed with family members F. Goals of therapy 1. " . . . Free family members of unconscious restrictions so that they’ll be able to interact with one another as whole, healthy persons on the basis of current realities rather than Unconscious images of the past." 2. Therapy focuses on supporting defenses and helping communication instead of analysis of defenses and finding repressed needs and impulses G. Conditions for behavior change 1. Insight is necessary - in family therapy expand that insight knowing that psychological life goes beyond conscious experiences. Want family members to understand and accept repressed parts of personalities. Need to work through those things. 2. Important for the therapist to establish a sense of security H. Techniques 1. Four basic techniques - listening, empathy, interpretation, and keep analytic neutrality 2. Don’t focus on reassuring or advise or confronting, silence is important. If they do intervene it’s to provide empathic understanding to help member of the family open up. Analysts also clarify things that appear to be hidden or need clarification 3. Mostly used with couples. 4. Therapists focus on the feelings associated with problems, not the causality to begin questioning about what’s at the root of the problem 5. Explore in four areas with couples: internal experience, history of the experience, how partner can trigger the experience, and how the context of session and therapist’s input might contribute to the situation 6. "Family dynamics are more than the additive sum of individual dynamics" (p. 228) 7. Therapist has to have a hypothesis

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VIII. Structure Family Therapy — Outline by Patty Salehpur A. Assumptions 1. Family are individuals who effect each other in powerful but unpredicatable ways 2. The consistent repetitive organized and predictable patterns of family behavior are important 3. The emotional boundaries and coalitions are important B. Salvador Minuchin 1. Always concerned with social issues 2. Developed a theory of family structure and guidelines to organize therapeutic techniques 3. 1970 headed Philadelphia Child Guidance Clinic where family therapists have been trained in structural family therapy ever since 4. Born in Argentina , served in the Israel army as a physician, in the USA trained in child psychiatry and psychoanalysis with Nathan Ackerman, worked in Israel with displaced children, also worked in the USA with Don Jackson with middle class families. 5. Fist generation of family structural therapists: Braulio Montalvo, Jay Haley, Bernie Rosman, Harry Aponte, Carter Umbarger, Marianne Fishman, Cloe Madanes, and Stephen Greenstein. C. Theoretical formulations - three essential constructs 1. Structure — the organized pattern in which family members interact, predictable sequences of family interaction, patterns of interaction. Structure involves a series of covert rules. There are universal and idiosyncratic constraints. Families may not be able to tell you the family structure, but they will show it to you in their interactions. 2. Subsystems — Families are differentiated into subsystems of members who join together to perform various functions. Each person is a member of one or more subsystems in the family. Some groupings are obvious and based on such factors as generation, gender, age or common interests. Other coalitions may be subtle. Every member may play many roles in various subgroups. 3. Boundaries are invisible barriers that regulate the amount and nature of contact with members. They range from rigid to diffuse, clear to unclear, disengaged to enmeshed D. Normal family development 1. Marriage begins with accommodation and boundary making 2. Couples are influenced by the structure of their families of origin 3. Couples also form boundaries with their families of origin 4. The advent of children requires that the structure of the family change E. The development of behavior disorders 1. Family dysfunction results from stress and failure to realign the structure to cope with it. 2. Disengaged families have rigid boundaries and excessive emotional distance. They fail to mobilize to deal with the stress. 3. Enmeshed families have diffuse boundaries and family members overreact emotionally and become intrusively involved with one another. These actions hinder mature actions to resolve stress. 4. Subsystems in the family may be disengaged or enmeshed. 5. Power hierarchies may develop which may be weak and ineffective or rigid and arbitrary. 6. Conflict avoidance prevents effective problem solving.

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7. Generational coalitions may also prevent effective problem solving. 8. Family structure may fail to adjust to family developmental processes. 9. A major change in family composition demands structural adaptation. 10. Symptoms in one family member may reflect dysfunctional structural relationships or simply individual problems. F. Goals of therapy 1. Changing family structure - altering boundaries and realigning subsystems 2. Symptomatic change - growth of the individual while preserving the mutual support of the family 3. Short-range goals may be developed to alleviate symptoms especially in life threatening disorders such as anorexia nervosa, but for long-lasting effective functioning the structure must change. Behavioral techniques fit into these short-term strategies. G. Techniques — join, map, transform structure 1. Joining and accommodating, then taking a position of leadership a. Listen to "I" statements 2. Enactment for understanding and change 3. Working with interaction and mapping the underlying structure a. Looking at the power hierarchies b. Using enactment to understand and clarify c. Looking at the boundary structures 4. Diagnosing a. individual vs. subgroup b. structural diagnosis 5. Highlighting and modifying interpersonal interactions is essential a. Control intensity by the regulation of affect, repetition and duration b. Don’t dilute the intensity through overqualifying, apologizing or rambling c. Shape competence, e.g. "It’s too noisy in here. Would you quiet the kids." 6. Boundary making and boundary strengthening a. Seating b. Seeing subgroups or individuals to foster boundaries and indivduation c. Clarify circular causation 7. Unbalancing may be necessary a. Taking sides b. Challenging c. Directives 8. Challenging the family’s assumptions may be necessary a. Teaching may be necessary b. Pragmatic fictions c. Paradoxes d. Therapist sometimes must challenge the way family members perceive reality, changing the way family member relate to each other offers alternative views of reality. 9. Therapists must create techniques to fit each unique family

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