Instructor Solution Manual for Couple and Family Therapy: A Case Approach, 1st ed by Nancy L Murdock
Instructor's Manual
D.
Couples and Family
Therapy: A Case Approach 1st Edition
Robert Casares, Jr., Wake Forest University
Nancy L. Murdock University of Missouri–Kansas City
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ISBN-10: 0-13-278027-5
ISBN-13: 978-0-13-278027-8
CHAPTER ONE: INTRODUCTION
CHAPTER OUTLINE
What is family?
“The family is a social system that supports survival and welfare of its members.”
However, what constitutes a family is varied, complicated, and expansive Counselors should approach couples and family counseling with respectful curiosity and an awareness of personal biases
What is couple and family therapy? Why do I use the term couple?
In couple and family counseling, the relationship rather than an individual is the client
A Brief History
Family therapy began in the 1940s and 1950s
British anthropologist Gregory Bateson introduced systems thinking and cybernetics to the profession of CFT
The Palo Alto Group eventually established the Mental Research Institute, which explored and advanced early theory in CFT
Notable early CFT figures included Jay Haley, Don Jackson, John Weakland, John Fry, Virginia Satir, Murray Bowen, and Salvador Minuchin
1970–1985: Strategic, Structural, Bowen, and Experiential theories were developed
1980s and 1990s: Increased emphasis on social constructivism and cultural diversity
Basic Systemic Constructs
The family is a system
The family is interconnected—each part affects other parts of the system Systems therapists are more interested in the process (how things happen in a family) than the content (the what) of the happenings
There are too many theories!
Review major theories before selecting one
It is valuable to learn about and practice a single theory during early efforts to become a CFT
Key considerations for selecting a theory: research support and how a particular theory fits with your assumptions about world and style of relating to others
Research
Research indicates that CFT approaches produce desired client change
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Types of research: outcome research and theory testing research
Choosing a Theory
Avoid trying to be integrative early in your career
The Theories I Chose
The CFT approaches presented represent traditional, postmodern/constructivist, and couples-focused theories
Conclusion—A Word About My Case-Based Approach
Each chapter starts with a case
After each construct, principle, or technique associated with a theory is introduced, it is applied to the chapter’s case
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CHAPTER TWO: STRATEGIC FAMILY THERAPY
CHAPTER OUTLINE
Overview and Background
Evolved from the work of early systems theorists, primarily the Palo Alto Group at the Mental Research Institute (MRI)
MRI researchers: Gregory Bateson, Jay Haley, Don Jackson, and John Weakland
Famously described the concept of double-bind communication
Basic Philosophy
Goal: Solving the problem as quickly as possible
Therapy focuses on the present and emphasizes action over insight
Central Constructs
Communication
Interested in repetitive sequences of interaction that are seen in families and dyads
Symptoms are viewed as attempted solutions to problems, although not satisfactory ones
Two levels of communication: report (or content) and command (or relationship) aspects
Hierarchies
Families, like any organization, involve power
Those at the top of the family are in charge and those lower in the hierarchy must obey
Hierarchies are only to be changed when necessary to change symptoms
Typical task for strategic therapists is to get parents back in charge
Theory of Development
Important life stages for strategic therapists: courting period, early marriage, childbirth and dealing with the young, middle marriage, weaning parents from children, and retirement and old age
Health and Dysfunction
Dysfunction is rigid, repetitive interactive behavior
Problematic hierarchies produce symptoms
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Confused and distorted hierarchies can even reside in healthy families
Nonpathological orientation: no problem exists unless the clients identify one
Healthy families have clear hierarchies that are consistent with the family’s cultural context
Nature of Therapy
Assessment
No formal assessment or diagnosis is used
Observation of interactions provides information about hierarchies and where they might be dysfunctional
Overview of Therapeutic Atmosphere
Therapist assumes responsibility for the structure of the counseling process
Flexibility with use of locations (homes, schools, traditional office space) and time frames for therapy (sessions can last 50 minutes to several hours)
Roles of Clients and Counselor
Few expectations for client roles
Strategic therapists are very active and directive
Shoulder total responsibility for the outcome of therapy
Closely observe, but typically do not interpret, the family’s ways of interacting
Invites cooperation and strives to establish a productive alliance with families
Goals
Resolve the presenting problem
Help clients navigate transitions between life stages
Help clients learn more complex ways of communicating and interacting with their systems
Process of Therapy
Formulate a problem that is solvable
Five stages: social, problem, interaction, goal setting, and task setting
Therapeutic Techniques
Directives
Reframing
Working with Hierarchical Problems
Pretend Directives
Evaluation of the Theory
Research Support
Outcome Research
Theory-Testing Research
Issues of Diversity
Family systems approaches are generally susceptible to the charge of cultural bias
However, this theory was not based on the traditional White family model
This approach is applicable with Black and Hispanic families, and its general predictions about triangulation mostly hold up in Chinese culture
Summary
Strategic family systems therapists focus on communication, interaction patterns, and hierarchies
Interventions are intended to change problematic hierarchical patterns to alleviate undesired symptoms
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CHAPTER THREE: STRUCTURAL FAMILY THERAPY
CHAPTER OUTLINE
Overview and Background
Most commonly associated with Salvador Minuchin Minuchin developed the structural approach in partnership with Jay Haley and Braulio
Montalvo
SFT influenced the later development of Multisystemic Therapy
Basic Philosophy
Rooted in systemic thinking
Individuals experience the twin pulls of belonging and being separate
Families are constantly balancing the tension between belonging and autonomy
Central Constructs
Family Structure
“The invisible set of functional demands that organize the ways in which family members interact”
Repeated patterns of interaction are the family structure
Subsystems
Families differentiate into smaller groupings that have different functions (e.g., parental, partner, sibling, etc.)
Boundaries
Rules that specify who participates in a system or subsystem
When boundaries are too rigid, the system is said to be disengaged
When boundaries are unclear, or diffuse, it is said to be emmeshed
Power and Hierarchy
Typically, parent figures have the most power, placing them at the highest level with children in subsystems below
Sometimes deviations in this hierarchy signify disfunction
Theory of Development
Four stages of family development: couple formation, families with young children, families with school-age or adolescent children, and families with grown children
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Becoming a couple requires partners to shift loyalties from their families of origin to their new entity, the partnership
The arrival of children requires the system to undergo serious realignment
Health and Dysfunction
Something about the structure is not working; the problem can typically be seen in the ways in which the family relates
Families tend to experience difficulties when old patterns of interaction stop working
Dysfunction is discussed as enmeshment or disengagement
Healthy families are those whose structures are clearly defined and flexible and up to the task at hand
A healthy individual can maintain a good balance between individuation and belonging to the family
Nature of Therapy
Assessment
No formal assessment; rather, a series of questions are considered
Some contemporary structural therapists use genograms to explore and document a family’s history
Overview of Therapeutic Atmosphere
Structural therapists strive to “modify the present, not to explore or interpret the past”
No one individual may be viewed as the problem
Roles of Clients and Counselor
Therapist is the expert joins with the family but maintains a stance as a leader in the counseling process
Goals
Changing the structure of the family
Solve the presenting problem
Impede old patterns of thinking and relating
Build on strengths to generate new patterns that lead to results
Process of Therapy
Therapist is both a leader and a member of the system
Four steps: Opening Up the Presenting Complaint, Highlight Problem-Maintaining Interactions, Structurally Focused Exploration of the Past, Exploration of Alternative Ways of Relating
Recognizing and acknowledging family strengths is critical
Therapeutic Techniques
Reframing
Enactment
Focusing
Achieving Intensity
Boundary Making
Unbalancing
Teaching Complementarity
Directives
Cognitive Intervention
Evaluation of the Theory
Research Support
Outcome Research
Theory-Testing Research
Issues of Diversity
Has been criticized for offering a traditional family structure
Implementing this approach with diverse families requires flexibility and thoughtful consideration of contextual issues
Summary
SFT is recognized as one of the major theories of couples and family counseling
SFT therapists help families change how they see family problems, and therefore to behave differently
Very little research has tested the efficacy of this approach
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CHAPTER FOUR: EXPERIENTIAL FAMILY THERAPY
CHAPTER OUTLINE
Overview and Background
Virginia Satir’s human validation process and Carl Whittaker’s symbolic-experiential family therapy are foundational approaches within this tradition
Basic Philosophy
Humanistic approach, which sees humans as agentic, positive beings with potential to grow if in the right circumstances
According to Satir, there are two ways to see people and the workings of the world: the threat and reward model and the seed model
Satir agreed with Freud: humans are motivated to love and work
Central Constructs
Self-Esteem
Defined as the degree to which individuals value themselves regardless of the opinions of others
One’s level of self-esteem is a product of early family experience
Self Mandala
Concept of wholeness, used to illustrate the eight aspects of human existence, according to Satir: physical, intellectual, emotional, sensual, interactional, nutritional, contextual, and spiritual
The self is at the middle of the mandala
Communication
The process and outcome of communication is critical to family life
At the most basic level, communication between two individuals is a request for validation of one by the other
Four problematic patterns of communication: placating, blaming, computing, and being irrelevant
Primary Triad
A grouping of three family members, or any three people
The nature of triangles often leads an individual to feel excluded from the relationship of the other two
A child’s idea about personal power are formed in relation to the primary triad
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The power of triangles can be both negative and positive
Family Rules
Can be overt or covert
Should be doable
Flexibility and age-appropriateness are also important
Should allow family members to share feelings and opinions freely
The Iceberg Metaphor
This model emphasizes that behavior is the only part of the iceberg that sticks out above the water
Below the water is the largest part of the iceberg: feelings, perceptions, expectations, yearnings, and the true, core self
Theory of Development
Five basic life stages: conception to birth, birth to puberty, puberty to adulthood, adulthood to senior status, and senior status to death
The most important forces in development are the people around us when we are young
Four important dimensions of family: individual self-esteem of members, communication patterns, rules of the family, and its relation to society
Seven processes are essential to becoming fully human: differentiation, relationships, autonomy, self-esteem, power, productivity, and loving
Health and Dysfunction
According to Satir, “All human beings carry with them all the resources they need to flourish”
Behavior is motivated by good intentions and represents the best that the individual knows
Satir believed that evil did not exist within people but, instead, in the process between people
Healthy people are honest with themselves and others
The problem is not the problem; coping is the problem
Nature of Therapy Assessment
Therapist observes the relationships among family members to gauge communication patterns
Self-presentations of family members give information about self-esteem
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Interactions among family members can yield information about covert and overt family rules
Overview of Therapeutic Atmosphere
Therapists approach families with optimism, warmth, and positivity
No prescribed treatments the therapist strives to tailor treatment to each family’s situation and needs
Roles of Clients and Counselor
Help people unlock their potential
Therapists serve as a resource and an expert, teaching families what they need to learn to communicate more effectively
Therapists must be in touch with themselves and nonjudgmental
Effectively working with families also requires the therapist to be humble, authentic, and genuine
Goals
Releasing the blocked potential of families
Engaging the healing power of clients
Enhancing self-esteem of family members
Helping family members become more aware of themselves and others
Process of Therapy
Three stages of therapy: (1) Contact: family members come to therapy in pain; (2) Chaos: One family member ventures into risky territory, revealing hurt, pain, and/or anger; (3) Integration: The family develops new ways of being and some closure is gained
Therapeutic Techniques
Family Sculping
Communication Analysis
Therapist Communications
Family Therapeutic Reading
Parts Party
Evaluation of the Theory
Research Support
Outcome Research
Theory-Testing Research
Issues of Diversity
Useful for working with clients and families from diverse cultural backgrounds
Might be inconsistent with the norms of some cultures that hold collectivistic values
Summary
Therapists working from the Satir model should create a safe, trusting environment for clients and families
Family members need to be able to express, experience, and love themselves and others
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CHAPTER FIVE: BOWEN FAMILY SYSTEMS THEORY
CHAPTER OUTLINE
Overview and Background
Bowen Family Systems Theory (BFST) was formulated by Murray Bowen (1913–1990), a family therapy pioneer who was influenced by evolutionary and natural systems theory
Bowen’s contributions grew out of his analysis of his own journey to differentiate a self in relation to his family of origin
Noted Bowenian scholars and practitioners include Michael Kerr, Thomas Fogarty, Philip Guerin, Katherine Guerin, Betty Carter, Monica McGoldrick, Daniel Papero, and Peter Titelman
Basic Philosophy
Adopts a neutral view of human beings
Contends that “the human family system springs from the evolutionary process and not from the human brain”
Practitioners are committed to thinking in terms of circular causality rather than in cause-and-effect mode
Holds that the basic motivator of human behavior is the need to balance the twin pulls of individuality and togetherness
Central Constructs
Differentiation of Self
Viewed as both an individual and a family construct
A lifelong process of managing one’s inherent tendencies to want to bond with others and to establish one’s self as separate
Should be thought of on a continuum
Individuals who are relatively well differentiated have a solid sense of self
Two dimensions: interpersonal (subdimensions: emotional cutoff and fusion with others) and intrapersonal (subdimensions: emotional reactivity and I-position)
Chronic Anxiety
Considered to be a natural biological phenomenon
An organism’s response to imagined threat as compared to acute anxiety, which is a response to real threat
Chronic anxiety is integral to understanding psychological dysfunction
Triangles
Most basic unit of human interaction, according to Bowen
Triangles involve three living people
At any given time, two of the people are “in” the group and the third is on the outside Sibling Position
Bowen believed that birth order has a profound influence on an individual’s relationship tendencies
Deviation from what is expected based on a particular birth position provides valuable information on levels of differentiation and family functioning
Theory of Development
The essential feature of human life is differentiation
The relative level of differentiation is transmitted by the family the parents’ levels of differentiation determine the children’s levels very early in life
The total amount of chronic anxiety experienced and the ways in which it is bound (triangles, couple conflict, symptoms, etc.) are related to the average level of differentiation of family members
As a result of all of the natural family processes, we all emerge with some degree of unresolved emotional attachment to our families, particularly our parental figures
Health and Dysfunction
Individuals and families are constantly struggling to balance the pulls of togetherness and separateness and never perfectly do so
Unresolved attachments are carried into future relationships and can cause problems
Four general patterns of relationship problems are seen when families are under stress: conflict in the couple’s relationship, dysfunction in a member of the parental couple, dysfunction in a child, and emotional distance
The development of symptoms reflects an overfunctioning–underfunctioning pattern
Differentiation of self and anxiety combine to determine the level of an individual’s functioning
Nature of Therapy
Assessment
Two basic techniques: informal assessment accomplished through questioning and the family diagram (also called a genogram) is the formal method of assessment
Overview of Therapeutic Atmosphere
Therapy is a research project through which all can learn about family process and defining a self with it
Single out the leader of the family (the person with the highest level of differentiation of self), as they are most likely to take steps toward differentiating
Roles of Clients and Counselor
Therapist is very active and seeks to stay “detriangled from the emotional process”
Effective BFST therapists are teachers and coaches
Therapists resist attempts to provide direct emotional support, approval, or reassurance
Goals
Promote differentiation of self
Reduce anxiety in the individual and/or system
Promote healthy family connections
Decrease emotional reactivity, increase self-focus, disrupt dysfunctional patterns
Process of Therapy
Therapist asks questions and focuses on “facts” rather than feelings
Strive to keep affect down in sessions so that all involved can be objective and operate on the basis of intellect instead of emotion
Clients are asked for perspectives and opinions rather than feelings
Therapeutic Techniques
Journeys Home
Process Questions
Establishing Person-to-Person Relationships
Observing Family and Controlling Emotional Reactions
Detriangling
Taking an I-Position
Evaluation of the Theory
Research Support
Outcome Research
Theory-Testing Research
Issues of Diversity
Bowen maintained that his theory and its constructs are universal; however, some question this assumption
The qualities Bowen associates with differentiation have been critiqued for seeming
closer to those associated with men
Also criticized for a tendency to blame dysfunction on mothers
Some have questioned the theory’s suitability for working with Hispanic clients/families
Others contend that the tenets and techniques of BFST are consistent with the expectations of individuals who are of Asian origin
Summary
Built-in pulls of togetherness and separateness as the driving force behind human behavior
Differentiation represents the ability to maintain a steady sense of self while engaging in meaningful intimate relationships
The antidote to dysfunction is to increase the level of differentiation in the individual or family
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CHAPTER SIX: COGNITIVE BEHAVIOR THERAPY
CHAPTER OUTLINE
Overview and Background
Cognitive behavior therapy (CBT) is a cluster of models and techniques
Involves several different perspectives on human learning that can be applied to working with families and couples (CBT-CF)
Influential figures and practitioners: Ivan Pavlov, John B. Watson, B. F. Skinner, Albert Bandura, and Albert Ellis
Basic Philosophy
Takes a neutral view of human nature
Human existence is discussed from an evolutionary perspective humans are organisms adapting to their environment
Behavior serves to obtain things that help people survive
How relationship partners think about each other and their behaviors is a strong influence on relationship functioning and health
Couples and families are interconnected systems
Central Constructs
Models of Learning
Three major models: classical, operant, and observational
Operant Conditioning
Behavior is maintained by its consequences (also called reinforcements)
Reinforcers are consequences that increase the probability that a behavior will occur
Two kinds of reinforcers: positive and negative
Extinction refers to the removal of a behavior maintaining reinforcement
Punishment, the opposite of reinforcement, is anything that reduces the probability of a behavior occurring
Desired behavior can be created by a process called shaping
Observational Learning
Plays a large part in the acquisition of new behaviors
Punished behavior can also be learned through observation
Schemas
The cognitive structures that organize the information with which a person is constantly confronted
Can be dominant or active, but we are mostly unaware of them
Influence the selection, encoding, and retrieval of information in the cognitive system
Automatic Thoughts
A normal feature of the cognitive process
Swift, evaluative statements or images that exist alongside our more conscious thoughts
Can be functional or distressing, but in either case, tend to be reasonable to the thinker
Beliefs
Rational beliefs are “logical and/or have empirical support, and/or are pragmatic”
Irrational beliefs are rigid, demanding musts or shoulds, which are usually, but not always, illogical and unrealistic
Five cognitions important for understanding relationship functioning: Assumptions, Standards, Attribution, Expectancies, and Selective Perception
Social Exchange Theory
Views relationships through the lens of rewards and costs associated with the relationship for each of the participants
Theory of Development
Interested in what members of couples or families have learned about relationships as they grew up
Some believe that patterns of behavior that can be observed in families may have been passed down by previous generations
Health and Dysfunction
Healthy families engage in adaptive behavior, which promotes survival of the individual and the family unit
Healthy relationships and families have more positive interactions than negative
Psychological dysfunction is maladaptive cognition and behavior
Family/couple distress is attributed to poor communication among members/partners and a lack of, or faulty, problem-solving skills
Nature of Therapy
Assessment
A very important part of CBT-CF
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Three main methods: interviews, self-report questionnaires, and therapist observations
Individual assessment may result in a formal diagnosis and consider supplemental individual therapy
Overview of Therapeutic Atmosphere
Therapeutic relationship is collaborative
First few sessions are structured as therapist performs the assessment
CBT-CF therapists are likely to teach clients the CBT treatment model, set an agenda and clear ground rules for each session, and assign relevant readings to their clients
Roles of Clients and Counselor
Primary role for therapists and clients is teacher–student
Goals
Modify and eliminate problematic cognitions and/or behaviors
Replace negative behaviors with positive ones, deactivate negative schemas, and change distorted or irrational thinking
Process of Therapy
Two distinct phases: assessment and intervention
CBT-CF therapist presents a summary of the assessment, which includes a view of presenting problem(s), strengths, and stressors
Next, the therapist and couple/family collaborate to set goals
The therapist provides a brief explanation of the CBT model and initiates the intervention phase
Therapeutic Techniques
Behavioral Techniques
Shaping
Reinforcement
Extinction
Punishment
Communication Training
Modeling
Altering Behavior Exchanges
Cognitive Techniques
Identifying Automatic and Distorted Thoughts, Challenging Irrational Beliefs
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Altering Selective Perceptions, Inaccurate Attributions, Inaccurate Expectancies, Unrealistic or Inappropriate Assumptions and Standards
Evaluation of the Theory
Research Support
Outcome Research
Theory-Testing Research
Issues of Diversity
Broad agreement exists that CBT can be adapted to a wide range of client diversity
Some Western-based principles of CBT may conflict with the values and norms of other cultures
CBT’s individualistic outlook may clash with the values of individuals and families from collectivistic cultures
Summary
CBT-CF offers a broad and flexible approach to working with individuals in relationships
CHAPTER SEVEN: SOLUTION-FOCUSED THERAPY
CHAPTER OUTLINE
Overview and Background
Key figures: Steve de Shazer, Insso Kim Berg, and Bill O’Hanlon
Early on, solution-focused therapy (SFT) was referred to as solution-centered, possibility therapy and collaborative, competency-based counseling
de Shazer and Berg met at the Mental Research Institute (MRI) in Palo Alto, California, and were married for 28 years
SFBT incorporates ideas developed at MRI
de Shazer and Berg later founded the Brief Family Therapy Center in Milwaukee, Wisconsin
Basic Philosophy
Rooted in optimism and believes in the power of language to create and define reality
There are no absolute truths
Humans create their realities through language and are capable of re-creating more helpful realities during times of trouble
Clients are referred to as “customers” and problems are called “complaints”
Key assumptions: (1) Clients have strengths and resources to resolve complaints; (2) change is constant; (3) the SF therapist’s job is to identify and amplify change; (4) it is usually unnecessary to know a great deal about the complaint to resolve it; (5) it is not necessary to know the cause or the function of a complaint to resolve it; (6) a small change is all that is necessary a change in one part of the system can effect change in another part of the system; (7) clients define the goal; (8) rapid change or resolution of problems is possible; (9) there is no one right way to view things; and (10) focus on what is possible and changeable rather than on what is impossible and intractable
Central Constructs
Exceptions
There are always times when the problem does not happen
The presenting complaint is not always present there are times when the client is successful and happy
Oftentimes, clients have not paid attention to exceptions
Change Talk
Problems are discussed in ways that hold the potential to bring about change
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Complaints are discussed in terms of behaviors that are amenable to change rather than using negative labels
Solutions
SFT focuses on what clients would perceive as an acceptable solution to the problem
Strengths and Resources
Therapists in SFT emphasize client strengths and already accessible resources
Theory of Development
SF advocates do not postulate a theory of development
A theory of counseling more than a theory of human nature
Not interested in the history of the problem, except in very rare circumstances
Health and Dysfunction
Therapists in SFT are not concerned with notions of health and dysfunction
Clients have complaints and therapists in SFT listen to the client’s construction of the problem, look for exceptions, and construct solutions
One way of looking at dysfunction is that clients are stuck
Nature of Therapy Assessment
Do not believe in traditional assessment
Therapists in SFT interview for solutions from the very start of counseling
Overview of Therapeutic Atmosphere
Clients typically complete four to five sessions, and most find their solutions in fewer than 10 sessions
Counselors strive to promote respect and cooperation and avoid passing judgment and making interpretations about client wants, needs, or behaviors
Roles of Clients and Counselor
Therapists in SFT take full responsibility for what takes place in sessions
Therapists take the lead and use a series of questions designed to elicit information about exceptions, solutions, and strengths
Three types of clients: visitors, complainants, and customers
Goals
Three primary goals: (1) change the doing of the situation that is perceived as problematic; (2) change the viewing of the situation that is perceived as problematic; and (3) evoke resources, strengths, and solutions to bring to the situation perceived
as problematic
Process of Therapy
First task is defining and redefining the problem
Once a solid relationship is established, the counselor will introduce change talk
Therapists in SFT focus on the present, not the past
Therapists in SFT interrupt problem-focused talk and redirect discussion to what clients would like to happen instead
The initial goal of the first session is to create a solvable complaint
The remainder of the first session is devoted to finding exceptions to the complaint and constructing concrete, solvable goals
Remaining sessions invite clients to take advantage of the “more of the same” principle—clients are encouraged to do more of what works and abandon what doesn’t
Therapeutic Techniques
Questions
Normalizing the Problem
Compliments
The Miracle Question
Scaling Questions
Asking About the Problem
Externalizing
First Session Formula Task
Generic Task
Breaking Patterns
Surprise Task
Write, Read, and Burn
Structured Fight
Do Something Different Evaluation of the Theory
Research Support
Outcome Research
Theory-Testing Research
Issues of Diversity
de Shazer argued that because therapists in SFT enter the client’s world, they avoid imposing their own perspective on the client
SFT is very focused and directive, which may clash with the values of clients from cultures that are less problem oriented in their approaches to living
Some argue that SFT may not be suitable for addressing particular issues, such as domestic violence and past experiences of physical or sexual abuse
Summary
Therapists in SFT approach couples and families with a model that focuses on client strengths and resources
The therapist is the expert on change, but the couple or family is the expert on how and what to change
Clients set the goals of therapy and therapists in SFT redefine the problem so that it is solvable
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CHAPTER EIGHT: NARRATIVE THERAPY
CHAPTER OUTLINE
Overview and Background
Narrative therapists see life as a process of storytelling
Narrative therapy (NT) is a relatively new theory rooted in a constructivist approach to psychotherapy
Key figures: Michael White, David Epston, Cheryl White, Jill Freedman, and Gene Combs
Basic Philosophy
Contends that there is no objective reality; instead, the way we view ourselves, others, and the social world in which we live is created (constructed) by social processes and interactions
Therapists in NT approach clients from a perspective that emphasizes health and strengths
Resists the individualizing of a client’s problems
Values accountability of therapists and clients
Committed to making therapy as transparent to clients as possible
Central Constructs
Stories
Human life is viewed as a series of stories
Some life stories are privileged over others, which become the client’s dominant narrative
Other types of stories: alternate, preferred, problem-saturated, and cultural discourse
Thinness and Thickness
Refers to the qualities of the stories families tell
Thin stories contain few events and sparse details
Stories become thick because they are told again and again and become embellished with each telling
Dominant stories are rich and thick, while alternate stories tend to be sparse and thin
Unique Outcomes
Events that are not part of the dominant, problem-saturated story
They are exceptions to the problem’s rule and are important for helping clients
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consider new possibilities
Five key types: action, reflection, protest, reconceptualization, and new experiences
Theory of Development
Not interested in traditional theories of development
More concerned with the family’s unique trajectory through life, cultural context, and each family member’s understanding of the current situation
Therapists in NT see humans as having multiple selves, the expressions of which are situationally determined
Health and Dysfunction
The term preferred narrative most closely reflects NT’s concept of health
A sense of personal agency is evident in members of healthy families
Narratives common to all people: fear and love
Problem-saturated stories diminish family functioning and well-being
Nature of Therapy Assessment
Therapists in NT are not very likely to use formal assessments
Focus on understanding clients’ perspectives on their lives
A series of questions are asked to better understand the life of the problem-saturated story
Overview of Therapeutic Atmosphere
Marked by a collaborative relationship
Process unfolds at the client’s pace
Therapist uses clients’ language typically their actual words and phrasing as a way of being sure they fully understand the stories shared in session
Roles of Clients and Counselor
Therapist in NT is a collaborator and consultant
Clients are experts on their lives
Therapist in NT adopts an attitude of respectful curiosity
Goals
The creation of new, more satisfying, stories for their clients
Deconstruct problem-saturated stories, identify unique outcomes, and reauthor narratives to support preferred outcomes
Process of Therapy
Clients tell their counselor stories
Therapists listen with curiosity and help clients deconstruct problem-saturated stories
Five stages: establish relationship, elicit problem stories, deconstruct dominant stories, embrace preferred stories, and live out enriched stories
Therapeutic Techniques
Questioning
Double Listening
Outsider Witness Practices
Taking It Back Practices
Written Artifacts
Evaluation of the Theory
Research Support
Outcome Research
Theory-Testing Research
Issues of Diversity
NT proponents argue that this approach is suitable for working with individuals, couples, and families from diverse cultural backgrounds
NT practitioners are well known for commitment to addressing diversity and social justice issues
Summary
NT is a constructivist approach in which counselors and clients collaborate to create new life stories
Therapists in NT help clients externalize problems, identify unique outcomes, and deconstruct problem-saturated stories
A new story can be created based on the deconstructed version of the client’s story
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CHAPTER NINE: EMOTION-FOCUSED THERAPY
CHAPTER OUTLINE
Overview and Background
Both an individual and couples counseling approach
Initially influenced by Gestalt therapy and humanistic/existential approaches
Eventually added aspects of systemic thought and attachment theory
Key figures: Les Greenberg originated the individual version while Sue Johnson focused on the application of emotion-focused therapy (EFT) to couples
Presently attempts to integrate individual EFT and couple EFT in order to help partners address unmet needs from the past and learn to self-soothe
Widely considered a valid approach for individuals, couples, and families
Basic Philosophy
Based in a humanistic philosophy, a “growth-oriented and nonpathologizing view of human functioning”
An integration of experiential and systemic perspectives
Members of a couple are generally seen as having healthy and adaptive needs and emotions
Couple functioning is a product of both internal and interactional processes
Four basic principles: (1) the self is organized by emotional experience, (2) organization of the self and interactional positions are a product of interpersonal perception, (3) individuals hold core beliefs that influence interpersonal interactions, and (4) interaction patterns have lives of their own
Central Constructs
Types of Emotions
Four types: primary adaptive, maladaptive primary, secondary reactive, and instrumental
Self
The self and the nature of one’s relationships with others are intertwined
The self is built on emotions and core beliefs about who we are in relation to others
Systems Constructs
Key notions: whole is bigger than its parts, circular causality, and an emphasis of process over content
Interaction Cycles
Patterns of communication that develop based on our experiences in relationships
Negative interaction cycles are self-perpetuating and thus become habitual
Theory of Development
Rooted in attachment theory
Attachment bonds are formed with parental figures during infancy
Good attachment figures are secure bases from which children can explore the world and are safe havens in times of stress
Unavailable or unresponsive parental figures contribute to dysfunction
Attachment styles developed early in life stick with an individual and influence how future relationships are managed
Health and Dysfunction
Four attachment styles: secure, anxious, fearful avoidant, and dismissive avoidant attachment
A securely attached person is a healthy one
Healthy couples: express their emotions, are able to weather inevitable ruptures, experience and express their distress to their partners, and receive their partner’s support
The common issues that bring couples to counseling involve attachment and identity issues
Identity threats result in shame, fear, and anger
Nature of Therapy
Assessment
Therapists look to identify primary and secondary emotions experienced by clients
Most important EFT assessment is of the negative interaction cycle
Overview of Therapeutic Atmosphere
Therapists in EFT strive to create a safe environment and a secure base for exploration, validate both partners’ experiences, establish a collaborative relationship and a strong therapeutic alliance
Roles of Clients and Counselor
Therapists in EFT serve as relationship coach and process consultant
Therapists in EFT should be genuine and congruent as they help clients express their thoughts and feelings
Clients are considered experts on their emotional experience but must be willing to explore their emotions and to learn how to change negative interactions
Goals
Modify or eliminate negative interaction cycles; change each partner’s experience of the relationship; establish a solid, safe, secure alliance with the couple; help partners identify and express emotional responses; restructure the couple’s interaction
Process of Therapy
Four steps: Validation and Alliance Formation, Negative Cycle De-Escalation, Accessing Underlying Feelings, and Restructuring Negative Interaction and the Self
Therapeutic Techniques
Empathic Reflections
Heightening Emotion
Enactment
Interpretation or Conjecture
Homework
Self-Soothing
Evaluation of the Theory
Research Support
Outcome Research
Theory-Testing Research
Issues of Diversity
Proponents of EFT argue that it is suitable for working with clients from diverse cultural backgrounds
Some question the universality of attachment theory and the uniformity of emotional expression
Summary
EFT is an experiential approach based in attachment theory
Therapists in EFT focus on negative cycles of interaction and help partners explore their emotions and learn how to change negative interactions
CHAPTER TEN: THE GOTTMAN APPROACH
CHAPTER OUTLINE
Overview and Background
Founders: John Gottman and Robert Levenson
Studied a wide range and a large number of couples over time
Used longitudinal methods to develop basic principles that separate Master Relationships from Disaster Relationships
Ideas have also been extended to parenting
Basic Philosophy
Rooted in attachment theory
Focuses on the good and bad elements of couple functioning
More of a clinical intervention theory than a theory of human behavior
Addresses relationship issues through collaborative teaching and coaching
Central Constructs
The Sound Relationship House (SRH)
Master couples build strong and stable houses based on trust and commitment
The foundation of the SRH is the couple’s friendship Trust
“Fundamental principle for making relationships work”
Involves a sense of feeling protected by one’s partner
The Four Horsemen of the Apocalypse
These are behaviors that disrupt and even destroy relationships: criticism, contempt, stonewalling, and defensiveness
Perpetual Problems
Gottman contends that 69% of problems faced by couples are unsolvable
Perpetual problems do not go away
Strong couples talk about such problems and try to understand one another’s dreams and values
Conflict and Repair
Discussions about difficult issues should be initiated in a gentle manner
Managing conflict involves making attempts to repair (e.g., cognitive and emotional)
Emotion, Flooding, and Attunement
Specific emotions are not the problem
How emotion is experienced and handled is critical
Flooding is the state of increased physiological arousal
Attunement refers to the awareness of one partner’s and one’s own emotions, accompanied by the ability to tolerate one’s patterner’s emotions without defensiveness and emotion
Theory of Development
Couples need to be emotionally available to each other
There are four types of couples: validators, volatiles, conflict-avoiding, and hostiles
Three-phase view of love: (1) falling in love, (2) building trust, (3) building commitment and love
Health and Dysfunction
Stable relationships endure, while unstable relationships tend to dissolve
Healthy relationships are responsive to each other’s bids for attention, are marked by friendship and mutual admiration, share values and dreams, and are capable of managing differences
In unhealthy relationships, partners tend to turn away from each other’s bid for attention, repair attempts are often harsh and futile and are marked by a dynamic of distance and isolation
Nature of Therapy Assessment
A core component of the Gottman Method
Conducted over three sessions: (1) joint session where the relationship history is constructed via the Gottman Oral History Interview and a variety of self-report instruments; (2) individual sessions with each partner to explore levels of commitment, expectations for the relationship and for therapy, thoughts about staying versus ending the relationship, and the occurrence of domestic violence and/or infidelity; and (3) feedback on assessments and the therapist helps to set goals
Overview of Therapeutic Atmosphere
Both parties need to feel understood and that their therapist is being fair
Strives for balance and positivity in an effort to help clients honor each other’s dreams
Roles of Clients and Counselor
Therapist is an expert in relationships who teaches couples about what research
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says about stable relationships
Therapist must develop an atmosphere of caring and respect
Couples need to be open to listening and learning about themselves and the Gottman Method
Goals
Decrease negative affect during conflict
Increase positive affect during conflict
Build positive affect during nonconflict
Bridge meta-emotion mismatches
Create and nurture shared meaning systems
Process of Therapy
Therapist creates rapid, dramatic change: get clients out of gridlock
Therapist focuses on structured change: teach clients how to manage conflict productively
Therapeutic Techniques
Dreams within Conflict
Dealing with the Four Horsemen
Building Love Maps
Stress-Reducing Conversations
Conflict-Management Training
Repair Training
Evaluation of the Theory
Research Support
Outcome Research
Theory-Testing Research
Issues of Diversity
Effectiveness with a diverse range of couples has been empirically demonstrated
Disclosure of emotions and processing conflict may be counternormative for some members of diverse cultural backgrounds
CHAPTER ELEVEN: CONCLUSION
CHAPTER OUTLINE
Where to Go from Here
As a beginning couple and family therapist, it might be best (less confusing) to choose one theory to start with
Which Theory Is Best?
Some theories have more research supporting their theoretical explanations than others
BFST, EFT, CBT, and the Gottman Method have been extensively researched
Structural, strategic, and experiential approaches have not been studied as systematically
Which Theory Fits?
You do not want to risk choosing a theory based solely on the fact that it matches your personal beliefs
Instead, you should be able to point to good quality evidence that supports your perspectives and practices
Another factor to consider is how these theoretical ideas lead to what you actually do in therapy sessions
Most theories require you to be active in sessions some require teaching or coaching, other approaches have more structured techniques, whereas others require you to be inventive and more in the moment
Preference for spontaneity versus structure may influence the theory you choose
Integrative Approaches
Sometimes called the “best of all worlds approach”
Able to harness the strengths of major approaches and open to adding new techniques as they are developed
Four general approaches: technical eclecticism, theoretical integration, assimilative integration, and common factors
Common Factors
Certain elements and mechanisms are proposed to operate in all effective therapies
Common elements: trusting therapeutic relationship, establish expectation that help/change is possible, therapist and client agree on the goals and tasks of therapy
In Conclusion
It takes time to settle into a theoretical home, and part of the fun is the process
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