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Family-System Therapy Theories and Practices An Introduction Copyright © 1997-2002 Melvin W. Wong, Ph.D. All Rights Reserved Melvin W. Wong, Ph.D. 黃偉康博士.

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Presentation on theme: "Family-System Therapy Theories and Practices An Introduction Copyright © 1997-2002 Melvin W. Wong, Ph.D. All Rights Reserved Melvin W. Wong, Ph.D. 黃偉康博士."— Presentation transcript:

1 Family-System Therapy Theories and Practices An Introduction Copyright © Melvin W. Wong, Ph.D. All Rights Reserved Melvin W. Wong, Ph.D. 黃偉康博士 Licensed Clinical Psychologist 220 Montgomery St., Suite 1098, San Francisco, CA 94104 1357 Mowry Avenue, Fremont, CA Tel (510) Fax (510)




5 “If I were a master Family Systems Theorist”
Course Requirements Class Attendance & Finish the Reader Each student is expected to complete one paper assignments A written report (about 10 pages) to be submitted to the office, entitled: “If I were a master Family Systems Theorist”

6 “If I were a master Family Systems Theorist”
When you become a master family systems theorist, how would you describe your system theory? Include your use of common terms: enmeshment, triangulation, etc. Include any new terms that you have invented? What about the relationship between husband & wife? What are your constructs? How do you do assessments? What are your therapy goals? How do you do interventions?

7 “If I were a master Family Systems Theorist”
How would your theory be different from the four theories we have discussed in class? In what way is your theory similar to the four theories we have discussed in class? What makes your theory relevant for Hong Kong Chinese families? What makes your theory relevant for Christians? How would you implement your theory in prevention efforts at church? How would you prevent divorces? What ministry can you provide for children of divorce?

8 Term Paper Due Friday, July 26, 2002 Handed in at Kay Wong’s office
If you need your grade to graduate, Please say so on the front page of your paper! (If you need more time to finish your work, please make an application for extension at the registrar’s office or through Kay Wong)

9 Class Time 09:00 to 10:30 AM Instruction session 1
10:30 to 10:45 AM Break 1 10:45 to 12:00 PM Instruction session 2 12:00 to 01:00 PM Lunch 01:00 to 02:30 PM Instruction 3 (or film) 02:30 to 02:45 PM Break 2 02:45 to 05:00 PM Instruction session 4 05:00 to 05:30 PM Q/A Individual Time

10 Course Description and Outline
This graduate marriage and family studies course provides fundamental introduction to the study of common marriage and family systems theories. Theories and techniques of family therapy will be reviewed and practical application discussed. The structural family therapy approach is studied in depth. Theoretical perspectives are presented through readings, lectures, and videotapes by the masters; classroom PowerPoint presentations and student demonstrations.

11 Course Objectives and Outcomes
Upon completion of this course, students will be able to understand and use the four predominant theories: The Structural Model, the Bowenian Model, the Satir model and the Strategic School. Students will be shown how to assess their counseling cases from a system's perspective using the theoretical framework from the above approaches, and to apply, to some extent, some of the intervention techniques covered. Cultural and theological and other relevant issues will also be addressed to assist students in this course to enhance their ability to minister through the local church.

12 Course Objectives and Outcomes
Students will establish a working knowledge of the historical developments central to Marriage and Family Therapy standards as well as marital and family counseling in general. They will have a working understanding of general systems theory, as well as a working knowledge of the major models of family therapy; they will understand family assessment, treatment planning and intervention techniques, from the perspectives of the various models discussed.

13 Assessment Criteria or Course Requirements
Students are expected to attend class minimum of 100%. There are assigned reading for the course based on the required textbook below. There will be either an examination at the end of the course or a term paper due. Students are expected to participate in classroom discussion as well as a short presentation of their papers if one is assigned.

14 Family Therapy: Concepts and Methods. Boston: Allyn & Bacon, 2001
Textbook Nichols, M.; Schwartz, R., Family Therapy: Concepts and Methods. Boston: Allyn & Bacon, 2001 (fifth edition).

15 Reference Books Goldenberg, I, & Goldenberg, H. (2000). Family Therapy: An overview. Needham Heights, MA: Allyn & Bacon, 5th ed. Haley, J. (1977). Problem-solving Therapy. San Francisco, CA: Jossey-Bass. Minuchin, S. (1974). Families and Family Therapy. Cambridge, MA: Harvard University Press. Satir, V. (1993). Conjoint Family Therapy. Palo Alto, CA: Science Behavior Books.

16 Acknowledgments & Credits
Michael P. Nichols, The Essentials of Family Therapy Curricula (English) References From: C. R. Barké, Ph.D.; Tamara L. Kaiser, Ph.D.; Michael I. Vickers, Ph.D. Curricula (Chinese) References From: 關何少芳 (香港家庭治療協進會主席) 黃張淑英 (香港家庭治療協進會學術秘書) 楊陳素端 (1990)

17 Videos by the Masters Key videos will be shown as direct illustrations from the masters of a particular theory. “Marriage: Just a Piece of Paper?” “Minuchin Interview” Other videos will be included on a time-permitting basis. "Unfolding the laundry," Salvador Minuchin

18 The family is the context of most human problems
The whole is greater than the sum of its parts Like all human groups, the family has emergent properties -fall into two categories Structure and Process

19 Family Therapy is New Psychiatry: Medical Model
Schizophrenia was not believed to be biological Family is not included in hospital treatment Family is believed to be the cause of illness Psychiatrists are not trained to treat families Change the Family to change the Person Change the Person and change the Family Theorists were smart researchers Studied different parts to improve the whole

20 Triangle-Triangles-Triangulation
A Three-Person system; according to Bowen, the smallest stable unit of human relationship. “Diverting conflict between two people by involving a third.” “The unhappy mother uses her last born son to triangulate against his father” She is unhappy with her marriage and to find stability and significance in her identity as a woman, she chose her youngest son to be a husband replacement: He is young and compliant

21 System (Family System)
Mary Richmond, 1917 Families are not isolated wholes (closed systems), but exist in a particular social context, which interactively influences and is influenced by their functioning (they are open). Her approach to practice was to consider the potential effect of all interventions on every systemic level, and to understand and to use the reciprocal interaction of the systemic hierarchy for therapeutic purposes.

22 Boundary Emotional and physical barriers that protect and enhance the integrity of individuals, subsystems, and families

23 The family is the context of most human problems
The structure of families includes triangles, subsystems, and boundaries. The processes that describe family interactions-emotional reactivity, dysfunctional communication, etc.-the most central is circularity. Rather than worrying about who started what, family therapists understand and treat human problems as a series of moves and countermoves, in repeating cycles.

24 What is the Family Systems Secret?
Fix the Marriage Then The Family is Fixed

25 Bad Marriage is the Context of Most of Human Problems
Family is Bad: Father & Mother are Bad Like all human groups, the family has emergent properties – Parental Happiness determines family happiness How to be Happily Married? and How to keep Children Happy?



28 Marriage: Just a Piece of Paper? Discussion
Cohabitation: No Marriage = No divorce No commitment, no security (Maturity issue) Consumerism in Marriage Relationships: “If I don’t like it, I move on” (Fear-reduction based) Divorce’s victims: Children (No advocate, no defense) Abandonment fear: “If mom & dad can split up, they can leave me too!” (limited cognitive abilities as children) Daughters of divorce: “Boy crazy, need a dad” (Intimacy) Sons of divorce: “What is the role of man in a family, none?” Covenant Marriage vs. Contract Marriage Premarital Counseling & Prove Fault before divorce

29 (available at the Baptist Seminary library)
Important Resource Marriage Clinic John Gottman (available at the Baptist Seminary library) G686m c.2

30 The Four Models of Family Therapy
Structural Model (Salvador Minuchin) Intergenerational Model (Murray Bowen, Boszormonyi-Nagy, James Framo) Humanistic-Experiential Model (Virginia Satir, Carl Whitaker) Strategic (Communication) Model (Jay Haley)

31 Complementary Relationship
Relationship based on differences that fit together in which qualities of one make up for lacks in the other Therefore, in marriages, there will always be differences because each spouse is different: This is the perpetual tension that exists in a marriage

32 Family Homeostasis Tendency of families to resist change in order to maintain a steady state

33 Group Dynamics Interactions among group members that emerge as a result of properties of the group rather than merely of their individual qualities

34 Identified Patient (IP)
The symptom-bearer or official patient as identified by the family

35 Videos by the Masters Salvador Minuchin Interview

36 Masters Series Videos Salvador Minuchin
First-born son from an Argentinean-Jewish family Complex, closed-extended family community: Gossips Defended Jewish identity & Argentinean freedom Imprisoned for political struggle against dictatorship: Peron Studied to be a pediatrician to be a child psychologist Worked with delinquent youths multi-culturally Dated & married “Pat”: “Capitalist” Spent 3 months: 1st date Visited other family therapy research groups ’70’s “Not a good team psychiatrist” “Not sexist” “Convinced” Empirical observations of families: Psychosomatic families

37 Subsystems & Boundaries
Families are structured in Subsystems as determined by Generation, gender, common interests and function which are demarcated by interpersonal Boundaries The invisible barriers that regulate the amount of contact with others Boundaries safeguard the separateness and autonomy of the family and its subsystem

38 Structural Family Therapy (Minuchin)
Constructs Structure The invisible set of functional demands (rules, roles, etc.) that organize the ways in which family members interact. These form repeated transactions or patterns of how, when, and who to interact with, which underpin the system and its functioning.

39 Structural Family Therapy (Minuchin)
Subsystems The family system differentiates and carries out its functions through subsystems, which include each individual as a subsystem, and other combinations, including generational, gender, interest, or function/role subsystems. Families typically include a marital subsystem, a parental subsystem, and a sibling subsystem.

40 Structural Family Therapy (Minuchin)
Boundaries To ensure proper family functioning, the boundaries of subsystems must be clear. A boundary is described as the rules that define who participates and how. It functions to protect the differentiation and separateness of subsystems and facilitate transactions among subsystems.

41 Structural Family Therapy (Minuchin)
Boundaries are described on a continuum From Diffuse 混雜邊界 (Enmeshment) Forming an enmeshed style of transactions in the system, to Rigid 分離邊界 (Disengaged Boundary) Forming a disengaged style of transactions in the system

42 Structural Family Therapy (Minuchin)
Healthy Family Functioning In healthy families, there is a clear hierarchy, with parents functioning as executive subsystem with effective power, children in a sibling subsystem, less power, though this changes developmentally over time.

43 Structural Family Therapy (Minuchin)
Boundaries are clear, flexible and permeable among all members, and between subsystems, meaning members can communicate with one another, can access others' time, attention and energy. Parents are aligned and function jointly, marital relationship is open internally, but clearly separate from children.

44 Structural Family Therapy (Minuchin)
Rules and roles are clearly and explicitly defined, yet with some flexibility across circumstances, and changing over time as children develop.

45 Structural Family Therapy (Minuchin)
Unhealthy Family Functioning In unhealthy families, any or all of these are missing or distorted. There may be overly rigid or diffuse boundaries between persons or subsystems, reversed hierarchy with children having too much power influence,

46 Structural Family Therapy (Minuchin)
coalitions across subsystems, conflict within subsystems, cross-subsystem alignments, rules and roles are ambiguous or conflicting, or remain fixed as children grow older, system may be disengaged or enmeshed.

47 Structural Family Therapy (Minuchin)
Therapy Goals Structural family therapy goals focus on restructuring, altering any or all of the structural components, thereby promoting changes in symptoms and symptom-maintaining behaviors of members.

48 Structural Family Therapy (Minuchin)
Examples of restructuring goals would be establishing an effective hierarchy, making boundaries more flexible or less diffuse, deconstructing coalitions, establishing healthy alignments, improving within subsystem communication,

49 Structural Family Therapy (Minuchin)
clarifying or establishing clear rules and roles, changing these to reflect developmental processes.

50 Structural Family Therapy (Minuchin)
Assessment Assessment is accomplished through a combination of inquiry, using circular questions as a tracking method, joining, with the therapist interacting with the family members, and observation using enactments in which the family interacts around a topic or issue. Family maps may be constructed by the therapist and/or members, depicting structural components.

51 Structural Family Therapy (Minuchin)
Interventions The therapy employs brief, direct, active restructuring interventions. The sequence of these may include joining, enactments, diagnosing, highlighting and modifying interactions, boundary making, unbalancing and challenging family assumptions (rules and roles).

52 Structural Family Therapy (Minuchin)
Others include shaping competence, emphasizing positive and effective behaviors; and reframing behaviors from negative to positive.

53 Virginia Satir Humanistic-Experiential Model
“If people are left alone, they tend to flourish!” (Carl Rogers) “Self-actualization” (Abraham Maslow) “Family myths” Mystification: Control to achieve peace and quiet Counter-Transference: Emotional reactivity on the part of the therapist Family Sculpting: Nonverbal experiential technique; family members position themselves in settings that reveal significant aspects of perceptions and feelings Role playing: Acting out the parts of important characters to dramatize feelings to practice new ways of relating

54 Virginia Satir Humanistic-Experiential Model
HUMANISTIC FAMILY THERAPY Constructs Open/Closed Family systems Satir views families as either open (functional) or closed (dysfunctional).

55 Virginia Satir Humanistic-Experiential Model
In closed families every individual must be very cautious about what he or she says; everyone is supposed to have the same feelings, thoughts, beliefs, and desires. Honest self-expression is impossible; differences are dangerous; members must become "dead to themselves."

56 Virginia Satir Humanistic-Experiential Model
An open system permits honest self-expression, differences are viewed as natural, members can say what they feel or think and can negotiate for personal growth and reality without threatening the system.

57 Virginia Satir Humanistic-Experiential Model
Family Roles Satir identified four family roles, which represent patterned ways that individuals may behave. blamer, placator, irrelevant distracter, super-reasonable computer.

58 Virginia Satir Humanistic-Experiential Model
As roles, each of these restricts or constrains open communication, though in different ways, and thereby limit growth and functioning of the system. 

59 Virginia Satir Humanistic-Experiential Model
Family Functioning Satir's approach is considered a "growth" model of functioning and therapy. In healthy families, the system nurtures its members, facilitating their growth and natural development, members listen and are considerate, value one another, and are open about themselves ("Anything can be talked about").

60 Virginia Satir Humanistic-Experiential Model
This promotes both the healthy self-actualization of individuals and the accomplishment of family goals and tasks. In unhealthy families, there are rules, roles and communication patterns which limit or prevent open, honest and expressive interactions among members.

61 Virginia Satir Humanistic-Experiential Model
Therapy Goals Satir's family therapy goals focus on the identification and habilitation of "process," rather than on symptom or problem reduction. The symptom is a signal of dysfunction in the family, and "the illness goes away when the individual is either removed from the maladaptive system,

62 Virginia Satir Humanistic-Experiential Model
or the system is changed to permit healthy response and communication" (Satir, 1967). Process is more a matter of "how" than "what," and she will focus on process rather than content.

63 Virginia Satir Humanistic-Experiential Model
Assessment Assessment is accomplished by Satir through the use of a "family life chronology," which is an interview process, that may span several sessions, or be interspersed across session.

64 Virginia Satir Humanistic-Experiential Model
It begins with the meeting of the couple, moves to their families of origin, returns to the planning of children, and then focuses on the routine facts of a typical day. Each member is involved in the process, and discuss feelings, hopes and disappointments as well as facts.

65 Virginia Satir Humanistic-Experiential Model
Diagnostically, Satir uses several tools, an analysis of the family's handling of differences; role function analysis; model analysis; communication analysis; and rule analysis.

66 Virginia Satir Humanistic-Experiential Model
Interventions Satir's interventions are a combination of her own responses and directives in session (encouraging the use of "I" statements, reframing), in session exercises, such as role-playing and sculpting, and games (rescue game, lethal game, communication game), and homework assignments.

67 Strategic Family Therapy (Haley, Madanes)
Constructs More interested in changing behaviors and patterns than in understanding them, more focus on technique than theory. Behavior in families is patterned and rule governed, often by the labels or interpretations placed on behavior. In families, hierarchy is crucial, and needs to be top-down and functional.

68 Strategic Family Therapy (Haley, Madanes)
Family Functioning Decline to identify "normal" functioning in any absolute sense – if it is working for the family it is healthy, if not, it is dysfunctional ("Non-normative"). Generally, though, in healthy families, there are functional rules that govern behavior, but also flexibility to attempt different solutions to problems that the rules do not work for.

69 Strategic Family Therapy (Haley, Madanes)
Families make misguided attempts to solve difficulties, when these fail they are termed "problems" and they repeat unsuccessful solutions, which makes the problem seem worse, an develops into a vicious circle. "Symptoms" are unsuccessful solutions. In unhealthy families,

70 Strategic Family Therapy (Haley, Madanes)
Therapy Goals Strategic family therapy goals focus on the presenting problem, or symptom. The goals are to eliminate the symptomatic behaviors or patterns of interaction which are experienced as distressing or prevent successful completion of individual or family tasks and development.

71 Strategic Family Therapy (Haley, Madanes)
Also to develop alternative behaviors or solutions which facilitate accomplishment. Let go of utopian, broad sweeping goals. Once presenting problem is eliminated, therapy is concluded.

72 Strategic Family Therapy (Haley, Madanes)
Assessment Assessment is accomplished through observation and inquiry about actual behaviors between and among members of the family, and of the ways behaviors are defined, labeled and interpreted.

73 Strategic Family Therapy (Haley, Madanes)
Three common types of unsuccessful solutions (symptoms) Solution is to deny that there is a problem; action is needed but not taken; Solution is an effort to solve something that is not really a problem; action is not needed but is taken; Solution is an effort to solve problem within a framework that makes it impossible for it to work; action is taken but at the wrong level.

74 Strategic Family Therapy (Haley, Madanes)
Interventions Approach to problems is to first identify the feedback loops that are maintaining the behaviors, then identify the frames (rules) that support these interactions, then change the rules.

75 Strategic Family Therapy (Haley, Madanes)
Interventions are strategies that are planned and implemented by the therapist, using directives, which may be straightforward or indirect or paradoxical. Process is one of interrupting, even reversing, unsuccessful feedback loops. Specific interventions include prescribing the symptom, restraining, prescribing ordeals, pretending, and rituals.

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