Family Therapy

The way forward

DEFINITION
Family: A family is defined as two or more persons who reside together; share economic resources; are related by birth, marriage, or adoption; and or who have a commitment to each other over time.

Family Therapy: A type of

therapeutic modality in which the focus of treatment is on the family as a unit; it represents a form of intervention in which the members of a family are assisted to identify and change problematic, maladaptive, self-defeating, repetitive relationship patterns.

Traditional Family: Its a common type of family system which includes father, mother & children. However, we should also give attention for the ignored yet increasing types of families such as, single parent families & blended or step families.

Functional Vs Dysfunctional Families

Flexibility Vs Rigidity
Clear Rules Vs Chaotic Open Vs Closed Effective Vs ineffective

nurturing

Individuation Vs

Enmeshment Mutuality Vs Isolation Parental Coalition Vs Disengagement

 Stability Vs

Disorganization Spontaneity Vs Intimidation Negotiation Vs Power struggle Assertion Vs Dogmatic

Clear Vs Unclear Roles or Role conflict Clear Vs Diffuse or Breached Intergenerational boundaries

COHESION

Flexibility__________Cohesion___________

Disengaged

Connected Cohesive

Enmeshed

1
Chaotic

8 7

Family Name___________________

Chaotically Disengaged

Chaotically Connected

Chaotically Cohesive

Chaotically Enmeshed

F L E Flexible X I B I Structure Ld I T Y Rigid

6 5 4 3
Mid-range Flexibly Disengaged Structurally Disengaged Flexibly Connected Structurally Connected Flexibly cohesive Structurally Cohesive Flexibly Enmeshed Structurally Enmeshed Balanced

2 1
Rigidly Disengaged Rigidly Connected Rigidly Cohesive Rigidly Enmeshed Unbalanced

Tips About healthy family (Idealistic Approach): Personality: Open*, Empathic, Unique, Self-esteemed, Responsible, Warm, Respectful, Autonomous, etc.

Open (1,2)

Closed (1)

Blind (2)

Dark

* Johari Window

Cognition: Realistic, Rational, Awareness of paradox, etc. Communication*: Clear Coding, No contradictions, expresses feelings, sense of humor, etc.

Models Encoder/decoder Intentionalist

Meanings Meaning is a property of messages On Speakers intention

Perspective-taking Addressees point of view Dialogic Emerged from participants joint * Communication Models activity

Network: Spouses separated from parents, Intergenerational relations respected & supported, boundaries respected, etc.

Elements of Assessment
ELEMENTS ASSESSMENT OF FUNCTIONAL DYSFUNCTIONAL

Communication

Clear Indirect, ,direct, open vague, and honest controlled , with with many congruence double blind between messages verbal and non verbal

ELEMENTS ASSESSMENT

OF

FUNCTIONAL

DYSFUNCTIONAL

Self concept reinforcement

Supportive, loving, praising, approving with behaviors that instill confidence

Unsupportive, blaming, putdowns, refusing to allow self responsibility

ELEMENTS ASSESSMENT

OF

FUNCTIONAL

DYSFUNCTIONAL

Family members

Flexible, realistic and d

Judgmental, rigid, ignoring individuality

expectation individualize controlling ,

ELEMENTS ASSESSMENT

OF

FUNCTIONAL

DYSFUNCTIONAL

Handling differences Family interactional pattern

Tolerant, dynamic, negotiating . Workable, constructive, flexible and promoting needs of all

Attacking, avoiding, surrendering . Contradictory, rigid, selfdefeating , and destructive

ELEMENTS ASSESSMENT

OF

FUNCTIONAL

DYSFUNCTIONAL

Trusting, Family climate growth promoting caring, general being

Distrusting, emotionally painful, absence of hope for

feeling of well improvement

Spec of Assessment Elements

1.COMMUNICATION
Making Assumptions: With this behavior one assumes that others will know what is meant by an action or an expression or other hand assumes to know what another member is thinking or feeling without checking to make certain.

Belittling feelings: This Action involves ignoring or minimizing anothers feeling when they are expressed. This encourages the individual to with hold honest feelings to avoid being hurt by the negative response.

Failing to listen: With this behavior one does not hear what the other individual is saying. This can mean, not hearing the words by tuning out what is being said or it can be selective listening, in which person hears only a selective part of the message or interprets it in a selective manner.

Communicating Indirectly: This usually means that an individual cannot present a message to receiver directly so seeks to communicate through a third person.

double minded message:

Double blind communication conveys

a damned if I do damned if I dont message. It may result Learned hopelessness in the childrens behavior.

2. SELF CONCEPT REINFORCEMENT

Expressing denigrating remarks: These remarks are commonly called put downs. Individual receive messages that they are worthless or unloved.

Withholding supportive messages: Family members find it difficult provide others with reinforcing and supportive messages.

Taking over: This occurs when one family member fails to permit another member to develop a sense of responsibility and self worth by doing things individually.

3.FAMILY MEMBERS EXPECTATIONS

Ignoring individuality: This occurs when family member s expect others to do things or behave in ways that do not fit with the latters individuality or current life situation.

Demanding proof of love: Family members place expectation on others behavior that are used as standard by which the expecting member determines how much the other member care for him or her.

4. HANDLING DIFFERENCES
Attacking: A different opinion can deteriorate in to a direct personal attack and may be manifested by blaming other person.

Avoiding:
With this tactic, differences are never acknowledged openly. Its indifferent kind of handling differences.

Surrendering: The person who surrenders in the face of disagreement does so at the expense of denying his or her own needs or rights.

5. FAMILY INTERACTIONAL PATTERNS

Patterns that causes emotional discomfort:
Interactions can promote hurt and anger in family members. These interactional patterns include behaviors such as never apologizing or never admitting that one has made mistake, forbidding flexibility in life situations.

Factors that intensify problems rather than solve them:

When problems go unresolved over a

long period of time, it sometimes appear to be easier it to ignore them. This may occur until the problem intensifies to a point at which it can no longer be ignored.

Patterns that are in conflict with each other: Some family rules may appear to be functional workable and constructive on the surface but in practice may serve to destroy healthy interactional pattern.

6. Others
Marital schism (split): Family in a constant state of disequilibrium through repeated threats of parental separation and communication masks conflicts Parents disqualify each other and join with children excluding the partner.

Marital skew (twist): Parental relationship is distorted; Relationship is not under threat, due to one excessively powerful and dominant parent.

Pseudo-hostility & Pseudomutuality: Disjointed or fragmented communication leads to disrupted interactions. Pressure is put on the child to avoid family relationships.

Mystification (confusion): Mystification occurs when one or more family members fail to understand the meaning, purpose of communication from another member; especially a parent. The communication received is often deliberately vague. The vague communication places the mystified person in an inferior position and leads to powerlessness.

Triangulation: Occurs when a third person is brought into a dyadic relationship to de-intensify a dispute between two people (generally the parents); Communication occurs through a third person.

The Elephant in the Room:

The problem that no one wants/dares to talk about and the problem are clearly visible to all involved; Fear of retaliation or negative consequences and shame often keep individuals from discussing the problem. Self blame is common. Victims continue to allow the problem to exist and not be discussed. (E.g. alcoholism, sexual abuse)

Lack of Differentiation: Autonomy is important for all individuals. It represents the degree of independence that an individual needs to function apart from others in a system. Fusion is the absence of autonomy; Lack of differentiation leads to enmeshment with others.

Scapegoating: Families often scapegoat one individual for all of the familys problems. Any fault will be attributed to this individual.

Lack of Boundaries: All individuals need boundaries. The absence of boundaries produces unclear limits in terms of what others may or may not say or do to a person. Without boundaries abuse can easily occur.

GOALS OF FAMILY THERAPY

Help families become aware of

their needs. Provide genuine, enduring healing Shift power to parental figures Improve communication

Continued
Make interpersonal,

intrapersonal, and environmental changes Keep substance abuse from moving from one generation to another Provide a neutral forum to solve problems

BASIC THEORETICAL CONCEPTS

Psychodynamic theory: The idea of interlocking pathology, arguing that the psychopathology of the different members of the family fitted together to produce the family system, which the therapist encountered.

Group therapy: The aim is to help the members of the group gain insight through the process of group interaction. The therapists role is principally that of facilitator and sometimes interpreter of what is happening between the group members.

Systems theory: General systems theory was proposed by Von Bertalanffy, defined a complex of interacting elements Hall and Fagan (1956) defined system as a set of objects together with the relationship between the objects and between their attributes. There are two systems Open system and Closed systems

Continued

Closed system is those in which there is no

interaction with the surrounding environment and shows entropy. Open systems such as families do not show entropy. There is a steady inflow and out flow of relevant information across the boundary of the system.

The relationship between supra systems, systems and subsystems:

Subsystem
Sys tem

Subsystem Subsystem
System

Subsystem

Supra System

Dysfunctional Vs Functional Subsystems

Mother

Father

Mother

Father

Son

Son
Dysfunctional subsystem Functional Subsystem

Ideas and concept of system theory:

Families and other social groups are

systems having properties which are more than the sum of the properties of their parts. (synergy) The operation of such system is governed by certain general rules. Every system has a boundary.

Continued

The boundaries are semi permeable

(something can pass through, others cannot or certain material can pass one way but not the other) Family systems tend to reach relatively, but not totally steady states. Growth and evolution are possible. Change can occur or stimulated in various ways

 Continued
Communication and feedback

mechanisms between the parts of a system are important in the functioning of the system. Family systems appear to be purposeful

Continued Events such as the behavior of individuals in a family are better understood as examples of circular causality rather than as being based on linear causality. Systems are made up of subsystems and themselves are part of supra systems.

Characteristics of systems:
Circular causality Linear causality describes the process whereby one event causes another. 2. Boundary Every system has a boundary, which mark it off from surroundings. They control emotional interchanges, closeness and joint action.
1.

3. Feedback 4. Equifinality The Process by which an open system maintains the same steady state with differing inputs.

Learning Theory:
Respondent conditioning This changes the behavior by altering the circumstances leading up to it. Operant conditioning It Changes the behaviour by altering the circumstances following it.

Communication theory:
a) It is impossible not to communicate b) Communication has a relationship aspect c) Punctuation is the important feature of

communication d) Communication may be dividing into digital and analogical varieties e) Communication is symmetrical and complementary interaction

SCHOOLS OF FAMILY THERAPY

Psychoanalytic : The family members are encouraged to free associate, that helps their thoughts to flow freely without conscious censorship, and to verbalize these thoughts.

 Continued

Psycho analytic therapist generally makes fewer comments, asks fewer questions and intervenes less actively. They usually refrain also from giving advice and form actively manipulating the families they treat.

Behavioral:
Behavior therapist applies the

principle of learning theory in treatment of families. Change in families conceptualized in terms of respondent conditioning, operant conditioning modeling or cognitive change.

 Continued

The behavior analysis

enables the therapists to develop a plan to alter the contingency or circumstances and cognitions often by direct intervention in the family.

Group Therapy Approaches: The family therapists have used some of the approaches of group therapy the role of a therapist is facilitator and sometimes interpreter of what is happening between the group members. Family members can certainly learn the value from each other in a group therapy setting.

FAMILY SYSTEM THERAPY

(CORE CONCEPTS)

Differentiation of self: Differentiation of self is the ability to define oneself as a separate being. Healthy families encourage differentiation.

 Continued

A person with well differentiated self recognizes his realistic dependence on others, stay calm and clear headed in enough in the face of conflict, criticism.

Triangles: The concept of triangle refers to a three personal; emotional configuration that is considered the building block of the family systems.

Mother

Father

Son

 Continued

Triadic interaction configurations which are the basic building block of any emotional system. When a two-party system becomes unstable because of anxiety, a third person is involved to stabilize them.

Nuclear family emotional process: The nuclear family emotional process describes the patterns of emotional functioning in single generation. Lower the level of differentiation, the greater the possibility of problem in the future.

Family projection process:

Couples are unable to work through un differentiation or fusion that occurs with permanent commitment may when they become parents, project the resulting anxiety on to the children.

Multigenerational transmission:
Interactional patterns are transferred from one generation to another. Attitudes, values, beliefs, behaviors and patterns of interaction are passed along from the parent to children over many lifetimes. So certain behaviors are existed within a family through multiple generations.

Genograms: It gives a picture of three or more generations (like a family tree) and notes important family dynamics, rules, patterns, mental health issues, etc.

Grand Father

Notes

Father

Notes

Son

Notes

Goal and Technique of the Therapy:

1) To increase the level of differentiation of self, while remaining in touch with the family system. 2) The intense emotional problems within the nuclear family can be resolved only by resolving undifferentiated relationship.

3) Emphasis is given to understanding the past relationship 4)Therapeutic role is that of a coach or supervisor

Therapeutic techniques include: 1.Defining and clarifying the relationship between the family members 2.Helping family members develop one to one relationship with each other and minimizing triangles within the system

Continued

3.Teaching family members about the functioning of emotional systems. 4.Promoting differentiation by encouraging I" position stands during the course therapy.

THE STRUCTURAL FAMILY THERAPY

(CORE CONCEPTS) Transactional patterns: These are the rules that have been established over time that recognize the ways in which family members relate to one another.

Subsystems: Subsystems are smaller elements that make up a large family system. Subsystem can be individuals or can consist of two or more persons united by gender, relationship, generation, purpose.

Boundaries: Define the level of participation and interaction among subsystems. Boundaries are appropriate when they permit appropriate contact with others while preventing excessive interference. Clearly defined boundaries promote adaptive function. Maladaptive functioning can occur when boundaries are rigid or diffuse.

Continued
Rigid boundary is characterized by decreased

communication and lack of support and responsiveness. Rigid boundaries prevent subsystem from achieving appropriate closeness or interaction with others in the system, rigid boundaries promote disengagement, or extreme separateness among family members.

Diffuse boundaries are characterized

by dependency or over involvement. In interferes with adaptive functions because of over investment, over involvement, lack of differentiation between certain subsystems. Diffuse boundaries enmeshment or exaggerated connectedness among family members.

GOAL AND TECHNIQUES OF THE THERAPY:

Goals: Goal of structural family therapy is to facilitate change in family structure. Its to restructure the family system to create clear and flexible boundaries.

Techniques:
Joining the family: The therapist must become the part of the family if restructuring is to occur. The therapist joins the family but maintains leadership position.

 Continued
He or she may at different times join various subsystems within the family but ultimately includes the entire family system as a target of intervention. Focusing: Exploring specific areas; Specific problems; specific individuals.

Evaluating the family structure: Even though a family may come for a therapy because of behaviour of one family member, the family as a unit is considered problematic.

 Continued

The family structure is evaluated by assessing transactional pattern system flexibility, potential for changing boundaries, family developmental stage and role of the identified patient within the system.

Enactment: Therapist has family enact an interaction to enable the family to try different ways of interacting. Intensification: Therapist increases the emotional aspects of interactions.

Unbalancing: Conscious attempt to form a coalition with one member against another or supporting one member at the expense of another to throw the family system off balance.

Restructuring the family: An alliance or contract for therapy is established with the family by becoming an actual member of the family, the therapist is able to manipulate the system facilitate circumstances and experience that can lead to structural change.

THE STRATEGIC FAMILY THERAPY

(CORE CONCEPTS)
The strategic model the family

therapy uses the interactional or communication approach.

 Continued In this model families considered functional are open system where clear and precise messages, congruent with the situation, are sent and received. Dysfunctional families are viewed as partially closed systems in which communication is vague.

Double blind communication: Double blind communication occur s when a statement is made and succeeded by a contradictory statement. It also occurs when a statement is made and accompanied by nonverbal expression that is inconsistent with the verbal communication. Double blinded communication often results in a damned if I do damned if I not.

Pseudo mutuality and pseudo hostility: Pseudo mutuality is characterized by faade (image, face) of mutual regard. Pseudo mutuality allows family member to deny underlying fears of separation and hostility.

 Continue d
Pseudo hostility is also affixed and

rigid style of relating, but the facade being maintained is that of a state of conflict and alienation among family members to deny underling fears of tenderness and intimacy.

Marital schism (split):

Family in a constant state of

disequilibrium through repeated threats of parental separation and communication masks conflicts, Parents disqualify each other and join with children excluding the partner.

 Continued

Mutual trust is absent and

competition exists for closeness with the children. Often partner establishes an alliance with his or her parents against the spouse. Children lack appropriate role model.

Marital skew (twist): Parental relationship is distorted; Relationship is not under threat, due to one excessively powerful and dominant parent. There is a lack of equal partnership.

 Continued

The marriage remains intact

as long as the passive partner allows the domination to continue. Children also lack role models when a marital skew exists.

GOAL AND TECHNIQUES OF THE THERAPY:

To create changes in

destructive behaviors and communication patterns among family members.

Therapeutic techniques involve:

Paradoxical intervention: A paradox can be called a contradiction in therapy or prescribing the symptom. The therapist requests the family to continue to engage in the behavior that they are trying to change.

Positive Reframing: Re
labeling a problematic behavior by putting into a new, more positive perspective that emphasizes its good intention.

 Continued

With reframing, the

behavior may not actually change, but the consequences of the may change owing to a change in meaning attached to the behavior.

NARRATIVE FAMILY THERAPY

The goal of therapy is to

transform clients stories and alter their identities. The centerpiece of therapy is questioning.

BASIC CRITERIA FOR EMPLOYING FAMILY THERAPY

Evidence of malfunctioning family group Evidence that family dysfunction is related to

the problems for which help is being sought. When a change is desired in the way a family functions

 Continued

Separation difficulties Family functions at the

paranoid schizoid level Severely disorganized families, functioning badly and poor socio economic circumstances

DIFFERENCE BETWEEN INDIVIDUAL THERAPY AND FAMILY THERAPY

INDIVIDUAL THERAPY View the individual asRelationships are the the agent of change Ask, why? Think causes B) linearly agents of change Ask, what? (AThink circularly (A and B mutually influence one another.) FAMILY THERAPY

INDIVIDUAL THERAPY Treat the mind Focus on the past Focus on content Recognize individual developmental trajectories

FAMILY THERAPY Treat the interactions

between individual Focus on the present Focus on process Recognize and development individual familial

INDIVIDUAL THERAPY Begin Therapy right now Focus on : causes, purposes, processes experience & perspective

FAMILY THERAPY Invite siblings Focus: relationships trans generational meanings, rules family in parents,

Concern with individual Concern

LIMITATIONS OF FAMILY THERAPY

Individual psychological factors

were neglected. Lack of clear operationalization of the constructs for research purposes Feminist Critique Race/Ethnic Diversity