1. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter 15Family, Couples, and Group Therapy

2. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins The phenomena of emotional bonding, role enactment, communication, sexuality, and the broader system that provides the context for a relationship become the focus of couple therapy when conflict occurs. Chisholm, 1996

3. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Interest in the family of the psychiatric patient has blended over the years to interest in the family as the psychiatric patient. This conceptual focus on the family as a whole instead of one individual member is the key element of the family therapy approach. Jones, 1980

4. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Groups are a crucial part of life experience for people.... They constitute a potent force for the prevention and remediation of personal and social problems. Brill, Levine, and Brill, 2001

5. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Learning Objectives After studying this chapter, you should be able to Describe at least three alternatives to the traditional nuclear family Articulate the developmental stages of the family according to Duvall’s theory of the family life cycle Compare and contrast characteristics of functional and dysfunctional families Explain the development of couples, family, and group therapy Understand the purpose of couples, family, and group therapy Analyze four different modes of family therapy, stating the role of the therapist in each mode Distinguish the goals of couples and family therapy

6. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Learning Objectives (cont.) Develop a couple or family assessment guide Formulate a list of the common nursing diagnoses applicable to families participating in family therapy Create a genogram and explain its usefulness in family therapy Recognize the advantages of group therapy Identify at least six factors considered to be essential components of group therapy Construct the stages of group development in group therapy Compare and contrast the nurse–therapist’s role in couples, family, and group therapy

7. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Overview of Families Family life cycle Healthy functioning families Dysfunctional families Culturally diverse families

8. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins History of Family and Couples Therapy Treating individuals with problems Including the family or couple Viewing the family as a system of relationships

9. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Family Therapy Approaches to family therapy Goals of family therapy Stages of family therapy

10. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Approaches to Family Therapy Integrative approach Psychoanalytic approach Bowen approach Structural approach Interactional or strategic approach Social network or systemic approach Behaviorist approach

11. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Establishing Goals of Family Therapy Facilitate positive changes in the family Fostering open communication of thoughts and feelings Promoting optimal functioning in interdependent roles

12. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Stages of Family Therapy The initial interview The intervention or working phase The termination phase

13. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins The Nurse–Therapist’s Role in Family Therapy The clinical nurse specialist or nurse practitioner can function in many highly skilled roles, one of which is serving as a family therapist. Nurses in the role of family therapists: – Conduct family assessments Family historygenogram – Participate in family teaching and education – Provide family therapy

14. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Sample Genogram

15. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Couples Therapy Types of couples therapy Couple assessment Goals of couples therapy

16. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Types of Couples Therapy Marital-relations therapy Contextual therapy Object-relations therapy Brief couples therapy

17. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Couple Assessment It requires the collection of more comprehensive data about physical or mental illness in either or both partners, difficulties in interpersonal and/or sexual relationship of the couple, and identification of any developmental issues either partner may be experiencing.

18. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Goals of Couples Therapy Resolve problems and conflicts that couples are unable to handle themselves. Establishment of trust and loyalty Enhancement of sexual intimacy Improvement in listening and expressive skills Establishment of empathy for each individual

19. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Group Therapy Characteristics of group therapy Types of therapy groups Establishment of a group Stages of group development Group leadership styles The nurse–therapist’s role

20. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Advantages of Group Therapy Decreased isolation and dependence Opportunities for helping others Interpersonal learning and development of coping skills Decreased transference to the therapist while developing the ability to listen to other group members

21. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins 11 Essential Elements of Group Therapy Instillation of hope Universality Imparting of information Altruism Corrective recapitulation of the primary family group Development of socializing techniques Imitative behavior Interpersonal learning Group cohesiveness Catharsis Existential factors

22. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Types of Therapy Groups Open groups Closed groups

23. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Five Models of Group Therapy Support groups Reeducation and remotivation groups Problem-solving therapy groups Insight without reconstruction groups Personality reconstruction groups

24. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Establishment of a Group Size Diagnosis of participants Age Gender Intellectual level Verbal or communication skills Motivation Social skills Individual client needs

25. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Stages of Group Development Orientation phase Working phase Termination phase

26. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Group Leadership Styles Autocratic group leaders Democratic group leaders Laissez-faire group leaders

27. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Role of the Nurse–Therapist in Group Therapy Guide individuals through a problem- solving process Task role functions Maintenance role functions In these roles, the primary purpose is to guide individuals through a problem-solving process by anticipating and responding to the needs and concerns of group members.

28. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Key Terms Autocratic group leader Brief couples therapy Closed groups Contextual therapy Couples therapy Democratic group leader Dysfunctional families Families Family therapy Group therapy Healthy functioning family Laissez-faire group leader Marital-relations therapy Object-relations therapy Open groups

29. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Reflection Reflect on the chapter’s opening quote: “Interest in the family of the psychiatric patient has blended over the years to interest in the family as the psychiatric patient. This conceptual focus on the family as a whole instead of one individual member is the key element of the family therapy approach.” Jones, 1980 ? Do you agree with the current conceptual focus of family therapy? If you do not agree with the conceptual focus, what changes would you make in your approach as a family therapist?