FAMILY THERAPY

The family is considered a system and the primary focus of treatment.

      Client's problem is often a symptom of dysfunction within family.

            May serve a purpose for the family.

            May have been handed down across generations.

Aspects of Family Functioning (and major concepts)

      1)   Structure: subsystems, boundaries and hierarchy

            Key subsystems include the spousal, parental, and sibling.

            Triangulation—two family members recruit a third member to reduce stress, increase
stability (often a dysfunctional solution in the long run).

      2)   Regulation: maintenance of balance

Homeostasis—feedback loops, like a thermostat, designed to maintain a stable
environment.  Related to the tendency of families to remain static and resist change.

      3)   Information: communication

            Double bind—contradictory messages received from important family member(s).

      4)   Adaptiveness: ability to change and accommodate stress

Primary Goals:

      1)   Improved communication; change how family members relate to one another.

                  The way anger and affection are communicated is especially important.

      2)   Improved autonomy and individuation

                  Requires the development and acceptance of differentness within the family.

Models of Family Therapy

1) Multigenerational--Bowen

               Family pathology viewed as a role-related pattern which is passed from generation to
generation (a three generation perspective).

               Fusion to one's family interferes with development of mature and unique personality.

               Need to find balance between individuality/separateness (self) and
togetherness/belonging (system)—a sense of self, differentiated from the family,
must be developed.

               Need to avoid reacting emotionally and be guided by thoughts--learn to respond, not
react, to the system.

               Therapist tends to remain emotionally detached.

               Goals: change individual within context of the system; reduce anxiety.

2) Human Validation Process Model--Satir

               Emphasis on communication and experiencing/expressing emotions.

               Three generation perspective--but more present oriented.

               Relationship of therapist with family (personal involvement) is critical (like Roger’s
person-centered approach).      

               Therapist is a model and facilitator; creates a supportive, nurturing, safe atmosphere.

               Focus on family rules--can either help family system function or lead to dysfunction.

                     Rules that are unrealistic, rigid, and inflexible are often dysfunctional.

                     Rules that govern individuation and communication are especially important.

               Goals: Better interactions, clearer & more open communication, expanded awareness,
and enhanced potential for growth.

3) Experiential--Whitaker

               An “atheoretical” approach that is based on existential/phenomenological beliefs—
stresses freedom/choice, growth/actualization.

               Focus on here & now family-therapist interactions; experience, not education, is key.

               Goals: Facilitate autonomy and sense of belonging.

               Therapist is instigator and coach; relationship between family members and therapist is
critical.

               Techniques focus on expressing blocked feelings and promoting openness, spontaneity,
creativity, playfulness.

4) Structural--Minuchin

               Emphasis is on family structure/organization as reflected by family member
interactions.

                     How, when, to whom do family members relate--and with what result?

               Family subsystems are analyzed.

                     Examine boundaries, hierarchy, alignment, and power.

                     Boundaries can be rigid (disengaged), clear/healthy, or diffuse (enmeshed).

               Symptoms result from structural failings.

               Family’s ability to adapt is often compromised because of the rigidity of structure and
competing demands of different subsystems (members play different roles in
different subsystems).

               Emphasis is on the present.

               Goals: reduce symptoms by restructuring family organization--developing healthier
boundaries among members and modifying transactional rules/patterns.

5) Strategic—Haley, Madanes

               Problem or symptom (not family structure) is the problem--treated as "real" and solved.

               Past attempts by family members to change behavior/solve problems in other family
members sometimes have made matters worse.

               Distribution of power and communication among members is a primary focus.

               Family is usually in the midst of a power struggle--an issue of control--which
eventually involves the therapist.

               Family understanding/insight is not considered important.  

               Emphasis on the present; process focused and solution oriented.                    

               Goals: change the behavior of family members (especially behavior related to power
balance) and shift family organization, so problem is no longer functional.

               Therapist is expert and director.

               Techniques include the use of directives, both straightforward and paradoxical.

6) Social Constructionism

               Belief in subjective realities; the meaning that is attached to events is critical.

               Focus on family stories/family narratives.

               Therapy, in part, involves breaking free of the oppressive, dominant stories of the larger
system (whether family, societal, or cultural)—similar to feminist therapy approach.

               Client, not the therapist, is the expert.

               Therapist is a participant-observer, consultant, collaborator, and facilitator.

               Goal: Generate new meanings by helping family members create alternative stories
(stories that instill hope with new possibilities); a related goal is empowerment.

               Changing the “viewing and doing” of perceived problems changes the problem.

               Miracle question: "If your problem were solved overnight, what would be different?"
Next, encourage the client to enact "what would be different."

Past focus (multigenerational, human validation process) vs. present focus (structural, strategic).

Family therapy techniques are many and overlap considerably across theoretical approaches, and
include:

Genograms/family maps

Sculpting

Reframing/reauthoring

Joining and unbalancing

Enactments & role playing

            Use of directives