Family Therapy

A systemic approach
 What Defines a family
Webster’s Dictionary definitions:
• Group of people who are (1) bound by
philosophical, religious, or other
convictions, (2) common ancestry, and
(3) living under the same roof. And
• Basic biosocial unit in society having
as its nucleus two or more adults living
together and cooperating in the care
and rearing of their own or adopted
children
The family as a system

 Systems are composed of units who have some

relationship to each other and are organized
around those relationships
 Solar system
 Educational system

 A change in one part causes a change in another

Systems Theory and Families
• System = organized unit made up of
interdependent parts
• Whole unit is greater than the sum of
its parts
• Change in any part affects all other
parts
• Family is system in which each
member has a significant influence on
all other members
The etiology of problems
 Family characteristics: Problems (even an individual’s
psychological symptoms) are assumed to be caused
by a dysfunctional family characteristic
 family boundaries/structure (adaptability and cohesion)
 the nature of family interactions

 Family Homeostasis: When disruption occurs, family

members try to regain a stable environment by using
strategies that decrease stress and restore balance.
These strategies are not always adaptive in long-run.
 Family characteristics: Boundaries

Boundaries are implicit family

rules that determine how family
members relate to each other,
including who talks to (or spends
time with) whom, how decisions
are made and by whom, and how
much family members know about
each other’s lives.
Family characteristics: Boundaries/Cohesion

 Enmeshment (very low differentiation)

 People are enmeshed (or fused) when they are unable to
think or act autonomously.
 People who are not enmeshed are autonomous and have
emotional separation from their family.
 A person’s level of differentiation is often related to his or her
parents’ level of differentiation. It’s often transgenerational.
 People with low levels of differentiation are more reactive to
environmental stressors. When under stress they are more
likely to try to resolve it by:
 Withdrawal
 Destructive conflict
 Dysfunction
 Triangulation
 Disengagement (very high differentiation)
Family Adaptability

 Adaptability refers to the family’s rules about

who does what and it’s ability to adapt as
necessary
 When there are few rules (or rules are not
enforced), family functioning is chaotic
 When the rules are too rigid, families have
trouble adapting to change
Family Circumplex Model
 The nature of change

 Change/healing occurs when family members

1) Gain insight about their dynamics

2) Change repetitive patterns that hinder the family

 Learn more effective ways of communicating

 Change family roles

 Develop more healthy boundaries

The Initial Interview 3

 Pre-session Planning: The therapist and family

determine in advance who will attend the session.

 The Joining Stage: The therapist joins with the family,

taking on their affective tone, tempo, language and
structure.

 The Problem Statement Stage: Who gets to initially

frame the “problem”? Sometimes the person who has
the least involvement with the problem is addressed
first.
Initial Interview (continued) 5

 The Interaction Stage: The therapist focuses in on determining

the patterns of interaction sustaining the problem.

 In-Session Conference: The therapist leaves the family for a few

minutes and confers with observers or takes a moment alone to
think about what has been said and how that relates to the
therapist's hypothesis regarding the problem.

 Goal Setting Stage: The therapist reaches an agreement with

the family on a solvable problem, stated in behavioral terms so
that all involved will know when the problem has been solved.

 Ending Stage: The therapist sets the next appointment and

indicates which family members will be present.

 Post-session: Debriefing and processing

Family Therapy Assessment Techniques

 Family Interview

 Circular Questioning: The same question is asked of each

family member.

 Family Sculpting: Assessment tool that examines power and

closeness in a family by asking each family member to
physically arrange all other family members in order of
relationships (or in reference to a particular salient event).

 Reenactment: Asking the family to act out a situation rather

than describe it verbally.

 Genogram: Gives a picture of three or more generations (like

a family tree) and notes important family dynamics, rules,
patterns, mental health issues, alcohol/substance use etc.
Assessment of Family Functioning
 Role of the symptom in the system
 Family dynamics
 Family roles
 Family life chronology
 Survival triad
 Survival stances
 Six levels of experience: the iceberg
 Self-worth and self-esteem
 Mind-body connection
Role of the Symptom in the System
Emotional Role
 Symptom has a role in the family system.
 Ex: Child’s exaggerated acting out may serve
to reduce tension in marriage by getting
parents on same page.
 Have emotional function in family system,
even if they are consciously and logically
unwanted.
 If therapist can understand how symptom
makes emotional sense, it will be easier to
help find ways to interact successfully.
Family dynamics
Problematic family dynamics
 Power struggles: Can be within family and couple or
with extended family member.
 Parental conflicts: Can involve parents disagreeing
about how to parent and care for children.
 Lack of validation: Family openly expresses little
emotional support or validation.
 Lack of intimacy: Minimal sharing of significant
personal information and one’s emotional life.
Family roles
Roles
 Each person’s role in family assessed to understand
function of problem.
 Possible roles:
 The martyr/victim
 The victim or helpless one
 The rescuer
 The good child or parent
 The bad child or parent
Family life chronology
Definition
 Timeline that includes major events in individual’s or
family’s life:
 Births and deaths.
 Important family events such as marriages, moves,
tragedies, major illnesses, job loss.
 Important historical events such as wars, natural
disasters, economic downturns.
 Gives both therapist and client insight into context of
problem as well as strengths and resources might
exist.
Survival triad
What it is
 Child, mother, and father and quality of relationship
between them.
 In this primary triad, a child learns how to be human.
 The triad should serve as nurturing system for child.
 When child is experiencing difficulty, therapist
considers how the nurturing function of these
relationships can be improved.
Six Levels of Experience: The Iceberg
Layers of the iceberg
 Behavior: Behavior on surface; external manifestation of person’s
inner world.
 Coping: Defenses and survival stances; come out in times of
stress, person may use different stances in different relational
contexts.
 Feelings: Present feelings that are strongly past-based, using past
events to interpret the present.
 Perceptions: Beliefs, attitudes, and values that inform one’s sense
of self; most formed when very young and based on limited view of
reality.
 Expectations: Strong belief about how life should go, how people
should behave, and how one should perform; most formed while
young and are unrealistic.
 Yearnings: Universal longings to be loved, accepted, validated,
and confirmed.
 Self-worth and self-esteem
How they are employed
 Consider aspects of the self that client values and aspects of
which he/she is ashamed.
 Self-compassion, or acceptance of one’s strengths and
weaknesses, is better indicator of happiness than self-esteem.
 People who overestimate abilities and worth have high self-
esteem but problems in interpersonal relationships due to
unrealistic expectations.
 People who are judgmental, impatient, or intolerant of others’
weaknesses are almost always equally harsh on themselves.
 As self-compassion and self-worth rise, people become more
realistic and tolerant of their own and others’ weaknesses.
Mind-Body Connection
What it is
 How emotional issues may be manifesting in the body,
either symbolically or functionally.
 Way body is used indicates person’s communication
stance:
 Congruent communication: Open and relaxed body
postures.
 Placating: Timid and reserved postures.
 Blaming: Pointing, angry, and stiff postures.
 Super-reasonable: Cold and distant postures.
 Irrelevant: Hyper and distracted
 5 Family Therapy Intervention
Techniques

 Reframing: The problem must be put into solvable,

behavioral terms, be referenced as a family problem
and not just the problem of one family member, and
be put into positive terms (i.e., what will happen, not
what won’t).

 Giving Directives: Creating or selecting an

intervention that will impact the presenting problem.
 Modifying the structure
 Switching roles
Family Therapy Techniques (cont.)

 Rituals: Symbolic acts that help the family move. (e.g.

burying a box that contains family anger.)

 Ordeals: An ordeal is a behavior that is more

obnoxious, frustrating, and time consuming than the
behavior that is considered the symptom. When the
symptom behavior occurs, the family is instructed to
perform the ordeal.

 Ambiguous Assignments: Helps break down linear

thinking and causes the family to be more creative in
problem solving.
Major Family Therapies

 1950’s: Several psychologists break away from psychodynamics

and argue that dysfunctional behavior is rooted in the individual’s
past and present family life.

 Jay Haley (and others) develop strategic family therapy.

 Virginia Satir develops conjoint family therapy

 Salvador Minuchin develops structural family therapy.

 Murray Bowens develops transgenerational family therapy.

 Carl Whitakers develops experiential family therapy.

Therapeutic Presence: Warmth and Humanity

Theoretical Foundations
 Based on Roger’s therapist qualities:
 Congruence
 Accurate empathy
 Unconditional positive regard
 The more congruent therapists are, the better they
create therapeutic warmth and humanity
Making Contact (creating rapport)
What it is
 Series of connections both within therapist and between
therapist and other.
 Therapist makes contact with each client in room, engages
mind, body, and spirit.
 Open-body positioning and congruent communication critical.
 Therapist works to help family members make contact with each
other.
Making contact involves
 Making direct eye contact with clients.
 Touching clients (e.g., shaking hands).
 Sitting or standing at the same physical level so that eye contact
is easy.
 Asking each person’s name and how he or she prefers to be
called.
Empathy
What it is
 An accurate understanding of another’s emotional reality.
 Conveys understanding of clients’ subjective, inner
realities.
 Doesn’t ignore client’s responsibility, take client’s side,
and avoids confronting inconsistencies.
 Emphasizes it is not wrong or right to feel a certain way.
 Simply how client feels and is “truth,” at least for now.
How it works
 Client sees other person has unique experience that is
also “true;” understand how realities may collide and
create problematic interactions.