A Special Workshop for the Illinois Counseling Associations 59th Annual Conference

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A Special Workshopfor the Illinois Counseling
Associations 59th Annual Conference

• By special request of ICA President
• Dr. Scott Wickman

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Family Counseling Since Then How to Survive
Everything and Live to Tell About It...A Purely
Subjective (but then what isnt) look at Family
Counseling

• Dr. Jeffrey K Edwards
• Northeastern Illinois University
• Department of Counselor Education
• Couple and Family Counseling Program

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• "A great deal has changed if you learned about
  Family Counseling prior to 2000. This 110 minute
  workshop will review our history, and teach you
  the basics of how to understand the Postmodern
  Shift, why we no longer are strategic, and how
  the Feminists set us straight!! (among other
  things).
• This presentation is dedicated to all who helped
  create a new way of thinking about people.

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My MFT Genogram
Minuchin
Chuck Kramer, MD Early Family Inst.
Madden 1967-74
Sandra Watanaby
Lutherbrook 1974-83
Milan Systemic
Bill Pinsof
Froma Walsh
Family Inst of Chicago 1980-82
Texas tech
Purdue MFT Howard Liddle
Brent Atkinson
NIU 1985-90
Tony Heath
MRI
Sara Schwarzbaum
NEIU 1991- Present
Anita Thomas
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A brief look at our past

• So we might all be on the same page,
• and yes, I have probably skipped a lot, but we
  only have 110 minutes, and I know you will have
  questions, lets look at where we have come from.

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Introduction - Meta Theories

• Carl Pepper, 1950s Study
• Formistic
• Mechanistic
• Organismic
• Contextualistic

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Formistic
In DSM-IV there is no assumption that each
category of mental disorder is a completely
discrete entity with absolute boundaries dividing
it from other mental disorders or from no mental
disorder. There is also no assumption that all
individuals described as having the same mental
disorder are alike in all important ways.
(American Psychiatric Association, 2000, p. xxxi)
Phrenology is a theory which claims to be able to
determine character, personality traits and
criminality on the basis of the shape of the head
(i.e., by reading "bumps" and "fissures").
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Mechanistic

• In philosophy mechanism is a theory that all
  natural phenomena can be explained by physical
  causes. With the Newtonian Age, and the Age of
  Enlightenment the whole world, including human
  behavior
• was explained mechanistics.
• The metaphor suggests that broken parts can be
  fixed, or repaired. All we need to do is find
  the pieces that need fixing.

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Organismic

• Organismic theories are a family of holistic
  psychological theories which stress the
  organization, unity, and integration of human
  beings expressed through each individual's
  inherent growth or developmental tendency.
• Ilya Prigogine
• Small systems
• Thermodynamics

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• Context is

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• Context is

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• Context is

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• Context is

• weeee

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• Systems theory comes from the General Systems
  Theory of Ludwig von Bertalanffy in the early
  1920's, and later at MIT with Jay Forrester.
  
• NON-SUMMATIVITY A series of inter-related,
  interdependent, interconnected parts whose, whole
  is greater than the sum of its parts.
  
• EQUIFINALITY systems have multiple means to an
  end.
  
• Homeostasis vs. Homeodynamic
• Open vs. Closed systems
• Circularity of causation
• Systems as Self Organizing
• Holons
• Systems job is to replicate itselfsimply that.

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Major Difference between Individual Model and
Family Systems Models

• An individual model sees problems as residing
  within an individual, i.e., psychopathology, or
  structural abnormalities.
  
• A family systems model sees problems as being
  imbedded within, and created by a family
  structures, i.e., intergenerational or present
  day context. (even though we are managed care)

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Early models of a family

• Like a mobile touched by the wind, a change in
  one part of the mobile effects all the
  other parts.
  
• Systems are interrelated, interconnected,
  interdependent parts whose whole is greater than
  the sum.
  
• Identified Patient (indexed patient).

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Bateson and others cybernetic model

• Systems as processors of information using
  cybernetic feedback loops.
  
• Positive (keep going) and negative (restraint)
  feedback.
  
• Family Systems as Mind (Bateson).
• First order and second order cybernetics
  (cybernetics of cybernetics).
  

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The MastersOur Founders

• Bowen
• Minuchin
• Satir
• Whitaker
• Watzlawick, Fish, Jackson, Weakland
  (MRI)
  
• Haley and mades
• Hoffman

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Bowen (family systems)

• Genogram
• Family as an emotional system
• Intergenerational transmission
• Nuclear family process can be of anxiety
• Differentiation of self from family rules
• Pseudo differentiated
• Triangulation
• Emotional cutoff from family of origin
• Maturation (differentiation) has its own time
  frame.

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Minuchin(Structural)

• Families and members exist within a structure,
  built through repetitive family interactions.
  
• Hierarchy is made up of both a hard side and a
  soft side.
  
• Structure- organized patterns and predictable
  sequences, become rules that exist in
  unmentioned, covert family operating principles.
  

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Minuchin

• Boundaries - Range from rigid to diffuse
• Rigid - rules are set in stone
• Disengaged member of family that is not
  involved with others.
  
• Diffuse boundaries are not well defined.
• Enmeshment - over involvement with family or
  member of family, at the expense of growth and
  change. Over doing support.

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Minuchin

• Joining meeting all family members where they
  are, and making them feel welcome.
  
• Challenging occurs only after you have become
  part of the system, most often as the leader.
  
• Dysfunction is meant to describe patters, not
  members of the family.

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Satir

• Experiential/communications model
• Primacy of the experience
• Person of the therapist
• Family Roles
• Scapegoat, hero, placater, blamer, etc.
• Goal of treatment
• Increased self-worth
• Clear, direct, honest communication
• Flexible and appropriate roles

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Whitaker (Experiential- Exestential )

• Experiential
• Each Session is considered the first and the
  last.
  
• Battle for Structure
• Battle for Initiative

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Watzlawick, Fish, Jackson, Weakland
(MRI)(Communications Theory)

• Early MRI emphasized communications
• All behavior is communication
• Communication has both a Report and a Command.
  (digital and analog)
  
• Meta communication is communication about
  communication.
  

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(Brief) Strategic

• Reframing
• Positive Connotations
• Prescribing the Symptom
• Giving homework
• Flexibility regarding theory
• Anything that can be done, can also be collapsed
  into the time allowed.
  

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Strategic Family Therapy The MRI Model

• The attempted solution is the problem
• 180 degrees
• restraints, and go slow messages
• paradoxical injunctions

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Watzlawick, Fish, Jackson, Weakland (MRI)

• Clients are either
• Customers
• Complainents
• Visitors
• Problems are imbedded in contexts
• Attempted Solutions are usually the problem
• Circularity of problem

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Milton Erickson

• Psychiatrist/Hypnotherapist (unconscious)
• Brief Therapy
• Metaphor, story telling,
• Influenced Strategic Therapy (Haley) and NLP
• Indirect methods
• Utilization
• Confusion
• Ordeals, paradox, seeding ideas.

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Haley

• Learned from Bateson, Erickson, and Minuchin.
• Homework, paradox, reframes,
• It is the therapist's job to change the patient,
  not to help him understand himself.
  
• Reframe the problem into something that is do
  able, changeable.
  

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Milan Team

• Palazzoli, Boscolo, Cecchin, Prata
• Later split to Boscolo Cecchin and Palazzoli
  Prata
  
• Bateson and Haleys work influenced them, and
  their systemic (circularity) model.
  
• Use of one way mirror, teams and breaks.
• Led to their holding all views of a family as
  Hypotheses, and all members of the team as equal
  in their view -

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Milan Team

• Invariant prescription
• Paradox and counter paradox
• Believed that families came to therapy with a
  paradoxical request families wanted the
  stability of an unchanged system, but also wanted
  the problem member of the family to be cured, and
  the problem rooted in the family system rather
  than in the individual.
• Games without end.
• Led to view that a pathological view of a person
  maintained the person in a place where change was
  all but impossible.

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Froma Walsh
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• Normal (Health Functional) Family Process
• Asymptomatic
• Normative
• Utopian
• Transformative Flexibility
• Developmental
• Resilient

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Since then

• In the late 80s a series of new(er) ideas began
  to emerge in the literature that informed us of a
  different way to conduct our family therapy
  sessions.
• Second order cybernetics
• Constructivism/ postmodernism
• Strength Based Therapy
• Feminism
• Couple Therapy needed to change
• We play (work) in a managed care world.

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(my) Heroes Since Then

• Gregory Bateson and Margaret Mead (still)
• Gollishian and Anderson (languaging systems)
• Michael White (Narrative)
• Steve deShazar and Insoo Kim Berg (Solution
  Focused and Death of Resistance)
  
• Tom Anderson and Ben Furman (teams)
• Heath and Atkinson (constructivist)
• Froma Walsh (resiliency)

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Second Order Cybernetics

• Gregory Bateson, Margaret Mead
• Cannot be involved without influence
• No Objectivity
• View
• Worldview

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Constructivism

• Maturana and Varela Chilean biologists
• Radical constructivism
• Santiago theory of Cognition
• Living systems are cognitive systems, and living
  as a process is a process of cognition. This
  statement is valid for all organisms, with or
  without a nervous system.

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Constructivist man

• Radical Constructivism
• Constructionism
• Social Constructionism
• Language can change reality. Worldviews.
• Focus can move (punctuation) from a problem focus
  to a solution (strength) orientaton. Multiple
  views of a situation

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Postmodernism

• Skeptical of truth.
• Relies on epistemology to explain phenomena.
• Resists universalism ideas.
• Resists Hierarchical views and methods
• Looks to collaboration, between members and
  within treatment/client systems.
  
• Co-Construction of new views and alternative
  methods.

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Strength Based Therapies

• Language informs us of our reality.
• Ennui 100 different names for snow.
• Language creates reality.
• Ken Gergen there is no true self but multiple
  selves according to context.

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Narrative Therapy

• Michael White a social worker from Australia
  was influenced by Batesons work, as well as
  postmodern philosopher. Michel Foucault ideas,
  and along with David Epston developed the
  narrative form of therapy.

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Narrative Therapy

• The person is not the problem, the problem is the
  problem.
  
• Problem-saturated stories about a person colonize
  and marginalize alternative stories and/or our
  preferred and alternative outcome.
  
• Unique Outcomes and externalizing
• Deconstruction of stories and retelling of
  alternative thick views. (Wicked)

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Solution Focused (forced)Therapy

• When is the problem not a problem?
• Doing more of what works.
• Jim Frey view
• Miracle Question
• Scaling questions

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Ken Gergen

• Postmodernity
• Multiple self via context
• DSM is for practitioner () not for client.

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What we have learned from FEMINIST FAMILY THERAPY

• From Feminist Family Therapy by Thelma Jean
  Goodrich, Cheryl Rampage, Barbara Eliman, and
  Kris Haistead, (W.W. NortonNew York, 1988.)
  

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• Feminism begins at home.
• The family is a fundamental source for
  transmission of norms and values of the culture.
  
  
• The family is traditionally viewed as the domain
  of women and deserves scrutiny by those concerned
  with the condition of women.
  
• It is in the family that individuals first learn
  what it means to be male or female - definitions
  of self which feminists regard as highly
  problematic in our society.

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• Generally, three gender-based assumptions define
  male-female roles, which feminists struggle to
  change
  
• 1. Men believe they should always have the
  privilege and the right to control womens
  lives.
  
• 2. Women believe they are responsible for
  whatever goes wrong in a human relationship
  
• 3. Women believe men are essential for their
  well-being - essential rather than merely
  desirable or enjoyable. Gender role stereotyping
  hurts families.

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• Both men and women are accountable for the
  quality of marital and family life.
  
• Rather than rigid role definition and difference,
  good relationships are marked by mutuality,
  reciprocity and interdependence.
  
• All people responsible for fostering the growth
  of our children are charged both with nurturing
  them and with helping them be proficient in the
  world outside the home.
• Family structure does not need to be hierarchical
  to carry out family functions, rather let it be
  democratic, responsive, consensual.

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• The respect, love and safety required for the
  best of human growth and enjoyment are equally
  possible in a variety of constellations lesbian
  relationships, single-parent families, dual
  career couples and others.
• Connection and autonomy are to be equally sought,
  and each is a necessary condition for the other.
  
• Power, as so far exercised by men, fathers and
  husbands, is not to be more equally shared but
  banished altogether and replaced by giving ones
  skills and influence towards the well-being of
  others just as one also does for ones own
  well-being.

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• Finally, feminist family therapy is a moral
  endeavor, based on a vision of human life and of
  the environment best suited to produce and
  nourish the life of each individual, regardless
  of gender or status.

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Couple Therapy needed to change

• From the famous survey that appeared in the
  Consumer Report, came the information that couple
  therapy was one of the most useless forms of
  counseling
• The work of John Gottman and others showed us
  that there were better, more research oriented
  ways of dealing with couples.

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Gottman Couple Therapy

• John M. Gottmans Laboratory dedicated over three
  decades toward the research of couples and couple
  therapy. They have hard data of both
  physiological and psychological events. Work is
  looking at both what makes couples fail and what
  makes them work.
• The success or failure of a marriage does not
  depend on whether there is conflict in a
  relationship, but on how the conflict is handled.

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Gottman Couple Therapy

• The Four Horsemen expressions of specific
  negative behaviors.
  
• Criticism
• Contempt
• Defensiveness
• Stonewalling

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Gottman Couple Therapy

• The Four Horsemen expressions of specific
  negative behaviors.
  
• Stonewalling an overwhelmed partner uses this
  to convey that (he) does not want to continue the
  interaction. It is usually a man, and the
  pattern is his withdrawal in the face of active
  pursuit and demands. Although the stonewaller
  appears hostile, his actual feelings are when is
  she going to stop.
• Physical sense of emotional flooding, and the
  person is so overwhelmed that they cannot even
  listen. This, of course, only serves to
  infuriate the partner more, and provoke their
  mate to engage, discuss, and be accountable.

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Gottman Couple Therapy

• When all four horsemen are present, Gottman can
  predict with 94 accuracy a divorce or separation
  will occur, usually within the early part of the
  relationship.
• Emotionally disengaged couples do not display the
  Four Horsemen, as they do not even care to get
  into these highly charged and emotionally
  embroiled battles. These couples live in quiet
  desperation but end up divorces usually within 7
  to 14 years. The relationship just slowly withers
  and dies.

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Gottman Couple Therapy

• Some problems are never solved, only new ways of
  bringing up the problem or getting around it are
  found. Find a degree of peace around it, and
  recognize that some issues will never be solved.
• Accept influence from each other. During an
  argument, yielding order to win in the
  relationship. Finding a point of agreement, not
  yielding to others will or point or surrendering
  oneself. (car in traffic analogy)

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Gottman Couple Therapy

• Repair attempts
• Interactions that decrease negative
  escalations.
  
• Goofy faces
• Saying something off beat
• Gives a brief diversion from the conflict
• Happy Couples use repair attempts all the time
• Response to repair attempts are usually positive
• Use them early in any conflict.

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Gottman Couple Therapy

• Bid Turn
• An invitation to interact is a bid. (bid for
  attention)
  
• Partners response will either improve or erode
  the relationship. Happily married couples rarely
  ignore their partners bids. 85 of bids are met
  with positive responses.
• Playful bids good natured teasing, gentle
  physical sparring of different sorts.
  
• Have better access to humor, and a bank of
  positive feelings about the relationship to rely
  on.
  

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Gottman Couple Therapy

• Re writing the past
• A couples description of the past predicts the
  future of the relationship.
  
• Those couples with negative views of the past,
  deeply entrenched in that view.
  
• Happy couples highlight their good memories.
• Oral History Interview
• Beginning of relationship
• Philosophy of marriage (togetherness)
• How relationship has changed over time
• What marriage was like in F.O.

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Gottman Couple Therapy

• Happy marriages look fondly at the beginnings.
  Even if things were not perfect, they tend to
  highlight the positives, and joke about the low
  points. Remember how positive they felt in the
  beginning.
• Unhappy marriages
• Negativity toward spouse
• Chaotic perceptions of life together
• Disappointment/Disillusionment

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Gottman Couple Therapy

• Happy Couples
• Fondness and admiration still in love.
• Remember first impressions with good feelings
• Believe that their spouse is worthy of
  admiration.
  
• Even though they acknowledge flaws in partner,
  they still have a sense that they are worthy
  honor and respect. When this sense is gone,
  relationship cannot be revived.
• Aware of Love Maps
• Expressive and descriptive of relationship
• Intimately familiar with partners world.
• Remember major events in each others world and
  keep updating these as they grow together.

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Gottman Couple Therapy

• Happy Couples
• Glorifying the Struggle
• Happy couples approach their hardships as trials
  to be overcome believe that the struggles make
  the relationship stronger (raising my kids)
  (families opposed to marriage, yet succeeding)
• Realizing that even the struggles within the
  relationship are what makes them strong and was
  worth the struggle.
  
• We-ness
• Languaging the togetherness. Have same beliefs
  and values. We built the house together.

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Gottman Couple Therapy

• Finally, the influence of the New Father
• The couples friendship buffers their struggle
  through transition to parenthood.
  
• It is the fathers fondness, awareness and lack
  of being negative during their early years that
  buffers his wifes negativity during
  childbirth.
• Gottman, J.

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Richard Schwartz

• Internal Family Systems Model (IFS)
• Roberto Assigioli - psychsynthesis

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Howard Little

• His work with adolescent substance abusers is
  family oriented, and has sustainable empirical
  research to back it up.
  
• Multidimensional Family Therapy (MDFT)

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• Multidimensional Family Therapy (MDFT) for
  Adolescent Substance Abuse
  
• (Center for Treatment Research on Adolescent Drug
  Abuse, University of Miami School of Medicine,
  2002)
  
• http//phs.os.dhhs.gov/ophs/BestPractice/mdft_miam
  i.htm

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Multidimensional Family Therapy (MDFT) is an
outpatient family-based drug abuse treatment for
teenage substance abusers (Liddle, 1992 Liddle,
2002a, 2002b). MDFT has been applied in several
geographically distinct settings with a range of
populations, targeting ethnically diverse
adolescents (White, African-American, and
Hispanic) at risk for abuse and/or abusing
substances and their families. The majority of
families treated have been from disadvantaged
inner-city communities.

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• Developmentally- and ecologically-oriented
  treatment, MDFT takes into account the
  interlocking environmental and individual systems
  in which clinically referred teenagers reside.
  The approach is manualized (Liddle, 2002b),
  training materials and adherence scales have been
  developed, and we have demonstrated that the
  treatment can be taught to clinic therapists with
  a high degree of fidelity to the model (Hogue et
  al., 1996 Hogue et al., 1998).

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We play (work) in a managed care world, and
pluralistic society.

• Family sessions are still paid at the individual
  rate.
  
• Postmodern and constructivist methods are taught,
  but perhaps not understood.
  
• Purists see family systems as a worldview for
  treatment, while others see it as a method or
  subgroup.
  
• Even though CACREP has a mandatory 60 hour
  specialty program, and AAMFT has specific
  requirements, anyone with a license can practice,
  regardless of their competency.

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Questions an Comments

• This Power Point is on line at
• http//www.neiu.edu/jkedward/ppt/MFT-SinceThen/

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The end

• Have a great time at this conference!!