1. Foundation Concepts in Family Therapy
Some of the Core concepts covered in Chapters 1-4
EPSY 6393 with Dr. Sparrow

2. Myths to be shattered
Health could be achieved only by leaving home; the hero myth
Freud: Effects of family were real, but they were intrapsychic, and in the past
Rogers: Self actualization could only be pursued in isolation from the family’s oppressive influence

3. Family therapy’s premises
That the forces of change are located external to us, in the family system
That change in any member affects the whole family – systems theory

4. Which approach is best?
Individual therapy when the social relationships are stable, and the person is in distress
Family therapy when the social relationships are unstable, and the person is in distress

5. Big concept: The Family is a System
The family system is more than a collection of individuals
It is an organic whole with its own identity and dynamics
Members function in the system differently than they do in isolation

6. Circular Causality
Based on the idea that we are in a constant feedback loop with the persons in our lives. Also referred to as “cybernetic loops,” or “synchronous feedback.”
Linear causal explanations try to find who is at fault, or to blame.
Circular causal explanations try to understand what each person is doing that sustains the problem, and what they can do differently to change the situation.

7. Family Therapy is simpler than you Think!
A Small Number of systems dynamics accounts for most family distress,
so relax, you
can do it!
Dr. Sparrow says

8. Group Theory: The Basis for Family Therapy
Group theory provided a foundation for understanding the family
Lewin
group is more than sum of parts
interaction could be curative
a focus on the here and now; ahistorical
Groups are inherently tense as members vie for freedom and services
Process dimension became more important than content: how, not what

9. How Groups differ from Families
Group members come to therapy to find a sanctuary in which to discuss problems vs. families bring their problems into the office
Group members can be assured that what they say in therapy won’t follow them home vs. families have to live with the consequences of their disclosures
Groups are comprised of equals without a past vs. families are comprised of unequal members who have a past and future together

10. Early Misconceptions
The mother-child bond was the source of all problems, e.g. “schizophrenegenic” mothers.
Parents are always to blame, and children have to be protected from them.

11. The First Family Therapists: The Palo Alto Group
Bateson’s work with communication in schizophrenic families led to some of the first important contributions the the field.
rules
Metacommunicaton (report and demand)
double binds
feedback, or cybernetics
homeostasis (Jackson)

12. Negative and Positive Feedback
When a family’s rules are challenged, the family usually treats this challenge as “negative feedback,” that is a reason to reassert its rules
Positive feedback is information that a family perceives as a call to change its rules.

13. Families Break down under Stress
Normal families need help when they can’t adjust to stress
Family rigidity, or a refusal to alter rules, keeps a family from adjusting to change
Life changes bring about
developmental stressors
environmental stressors

14. Big Concept: Families resist change
Homeostasis means that families resist change
Direct attempts to foster change will evoke resistance
Insight is unnecessary, and can even get in the way.
Therapist must take an indirect approach in order to succeed

15. Relationships are Symmetrical or Complementary
Symmetrical relationships have a lot of similarity and equality -- common ground, comfortable
Complementary relationships are based on differences, opposite attraction -- not much common group, very dynamic
The pursuer-distancer dynamic grows out of complementary roles

16. Triangles are a basic structure in dysfunctional families
Triangles form when a person seeks out a substitute for relating to a person with whom he has difficulties
Cross-generational coalitions are a triangle between two generations; that is one parent joining with a child against the other parent.

17. Palo Alto Brief Therapy School
Based on the idea that families resist change
Assumed that a direct approach would only provoke resistance
downplayed importance of insight; in fact, considered insight to be an obstacle at times

18. Milton Erickson’s influence on Jay Haley
Erickson mastered techniques for circumventing resistance in hypnotic subjects.
Symptom prediction, symptom prescription (paradoxical or strategic)
Indirect methods
Reframing

19. Bowen’s Systems Family Therapy
differentiation of self is central concept
triangle is smallest stable unit of relationship.
cross generational transmission of patterns; focused on the family of origin, not the nuclear family
genograms as a way of assessing generational patterns

20. Whitaker and Satir: Experiential Family therapy
Existential-humanistic, person centered
Believed that family members needed to unlease their true feelings, and become more honest with each other.
Believed that humans were essentially good, and just needed to be helped in expressing the truth of who they are.

21. Minuchin’s Structural Family Therapy
boundaries; disengagement and enmeshment
hierarchies
joining
enactment
restructuring

22. Origin of Family problems
As already stated, families break down when unable to adjust their rules to accommodate new developments
Family therapists are interested in what was happening when the problem arose
But more interested in what the family is doing to perpetuate the problem
The family’s “solution” is often the problem -- the reassertion of old rules

23. Process is Everything
As mentioned earlier, a therapist must focus on what is going on between members, not the specific problem
If a therapist tries to solve the problem as it’s defined, rather than looking at the way the family sustains the problem through their interaction, there will be no progress.

24. What you do depends on Your style and theory
Some therapists will openly point out the problems in relating, in order to bring about insight.
Some therapists will actively manipulate the family (move them around, get them to interact, etc.) to bring about change in the session, without worrying about insight.
Some will do both.

25. Major interventions Joining -- Minuchin Process Questions -- Bowen
Genograms -- Bowen
I position (to stop blaming) -- Bowen
Reframing -- Haley, Minuchin
Paradoxical interventions and therapeutic double binds -- Haley
Enactment and restructuring-- Minuchin

26. Session Objectives: First session
Joining: Making contact with each person. Balance warmth and professionalism to prevent induction.
Assess problem from each person’s perspective
Explore specific problems and attempted solutions: Use process questions to explore.
Develop hypotheses about the interactions that are sustaining the problem.

27. Early Phase Objectives
Keep it simple. Focus on primary problems and the dynamics perpetuating them.
Formulate hypotheses around structure and dynamics, not so much the personal or intrapersonal aspects.
Bring the problem into the office. Allow interaction and support “enactments.”
Reframe, challenge, and restructure the enacted dynamics around new boundaries
Assign homework that continues the new relationship dynamics

28. Mid-Phase Objectives
Foster responsibility; challenge the blame game with process statements/questions, unbalancing, and reframing
Keep your efforts related to primary complaint, but your interventions focused on interactive process.
Use intensity to challenge members to demonstrate their competencies
Don’t splinter the family into subgroup work without keeping the big picture in mind.

29. Termination
A time for the family to evaluate its progress, and to consolidate what they’ve learned.
Do they get it?
Are the benefits being seen elsewhere? (generalization of therapeutic gains)
Are they satisfied?
Can they do it on their own? Are relapses merely part of the growth process, or are there problems that you still need to address?
Immunization strategies: preparation for relapse

30. Exceptions and Ethics Issues Pertaining to Marital and Family Work
Child abuse
Domestic violence
Confidentiality, triangulation, attraction

31. Chapter Four: Deepening Our Knowledge of Systems
Cybernetics revisted: Sequences of family dynamics; negative and positive feedback
Closed systems and open systems; therapist role; living systems are open, and exhibit:
equifinality
morphogenesis -- tendency to seek change

32. Chapter Four: Deepening Our Knowledge of Systems
Systems dynamics explains several relationship problems that tend to get worse without outside intervention:
Controller/rebel
Approacher/distancer
Overfunctioning/underfunctioning

33. Chapter Four: Deepening Our Knowledge of Systems
Systems dynamics are revealed through spontaneous sequences of behaviors. These sequences tend to erupt early in the family therapy sessions. By allowing them to occur, you can see the problem in action, and (depending on your approach) can intervene to get the family to correct it.

34. challenge to Early Family therapy: Social constructionism
Relates to the age-old notion that knowledge of the world is filtered through beliefs, experience, and language, and relationships
Reframing is a constructionistic technique: co-creating reality
Moves therapy into the cognitive realm, away from focus on behavior.
Minimizes the importance of the therapist as an expert

35. Constructionism challenges Prevailing “Truths”
Cultural and gender assumptions vary over time, so roles are changeable.
Social “truths” become enshrined within prevailing approaches to therapy
“Deconstruction” of the socially constructed narrative is essential.
Collaboration is essential within a social constructionist approach

36. Attachment Theory
Is a way that family therapy has reintroduced psychodynamic concepts into relational events.
Assumes that the basic human impulse is to form secure bonds, or to seek closeness in the face of stress.
When the formation of secure bonds are disrupted, a child reacts in two different ways.
Resistance/clinging
avoidance

37. Summary
Context is more important than content, so it is important to meet with the family to establish the context of a person’s distress.
People are complementary, and will compensate for their partners’ style by going the other direction. This creates a number of “workable” problems.
Families and couples are constantll engaged in circular exchanges. Solutions have to take this into account.

38. Summary
Triangles account for much of a couple’s or a family’s dysfuntion. Direct communication or “detriangling” is the solution.
Process is always more important than content.
Family structure determines how people relate. (Boundaries are the key)
Enmeshment
Disengagement

39. Summary
Symptoms can benefit a family by helping members avoid other issues.
Families pass through a predictable life cycle, and face predictable challenges related to each stage of developoment.
Resistance is normal and healthy. Don’t fight it, but create a trusting relationship with the family and an environment that is comfortable.

40. Summary
Family stories or narratives can help the therapist understand how to intervene.
Gender roles and assumptions play a huge role in family distress.
Culture and ethnicity –It is important to be respectful of these factors, but it’s also important to confront counterproductive beliefs and values regardless of their source.