Family Systems Therapy

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Family Systems Therapy

• James J. Messina, Ph.D.

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Family Therapists Leaders

• Alfred Adler-Rudolf Driekurs-open forum Child
  Guidance Clinics
• Murray Bowen-Multigenerational Model-Triangulation
  , Differentiation of Self
• Virginia Satir-Conjoint Family Therapy-Human
  Validation, Relational Family Therapy
• Carl Whitaker-Experiential Symbolic Family
  Therapy-therapist coach influences change
• Salvador Minuchin-Structural Family
  Therapy-create structural change
• Jay Haley-Strategic Family Therapy-solves
  problems now
• Cloe Madanes- Wife Haley-Strategic Family Therapy

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The Family Systems Perspective

• Individuals are best understood through
  assessing the interactions within an entire
  family
• Symptoms are viewed as an expression of a
  dysfunction within a family
• Problematic behaviors
• Serve a purpose for the family
• Are a function of the familys inability to
  operate productively
• Are symptomatic patterns handed down across
  generations
• A family is an interactional unit and a change
  in one member effects all members

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Difference between Systemic Individual Therapy
models
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Beliefs of Family Therapists

• Individuals affiliations interactions have
  more power in persons life than a single
  therapist could ever hope to have
• Working with family or community therapists sees
  how individual acts and serves needs of these
  systems
• Seeing individual in active in a systems assists
  in developing types of interventions needed

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Systemic Perspective

• Individual may carry a symptom for the entire
  family
• Individuals functioning is a manifestation of
  way family functions
• Individual can have symptom existing independent
  of family structure
• Symptoms always have ramifications for family
  members
• Change the systems and individuals will change
• Change dysfunctional patterns of relating
  create functional ways of interacting relating

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Adlerian Family Therapy Outline

• Key Concepts
• Therapy Goals
• Therapists functions

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Adlerian Family Therapy Key Concepts

• Adlerians use an educational model to counsel
  families
• Emphasis is on family atmosphere and family
  constellation
• Therapists function as collaborators who seek to
  join the family
• Parent interviews yield hunches about the
  purposes underlying childrens misbehavior

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Family Atmosphere

• Unique conjunction of all the family
  forces-climate of relationships that exist
  between people
• Family is a system each member exerts influence
  on every other member
• Autocratic or permissive common in West
• Parent role model of how genders relate, how to
  work, participate in world
• Emotional role models for children as well
• Family value value all members support cannot
  be ignored religion, education, money
  achievement, right and wrong

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Family Constellation

• Consists of parents, children, extended family
  members
• Birth order
• How member find place in family system how
  relate to one another to be unique
• Alignment of family members
• Develop genogram of family-starting point for
  client communication meaning of life

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Role of Birth Order

• Motivates later behavior
• First-born favored, only, pseudo-parent-high
  achievers
• Second-born rivalry competition
• Last-born more pampered, baby-creative,
  rebellious, revolutionary, avant-garde

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Birth Order

• Adlers five psychological positions
• Oldest child receives more attention, spoiled,
  center of attention
• Second of only two behaves as if in a race,
  often opposite to first child
• Middle often feels squeezed out
• Youngest the baby
• Only does not learn to share or cooperate with
  other children, learns to deal with adults

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Mistaken Goals Interactional View

• Four goals for childrens behaviors
• Attention getting
• Power struggle
• Revenge
• Demonstration of inadequacy
• Short hand explanations, descriptions of
  consistent patterns
• Describe childs misbehavior
• Parents reaction to behavior
• Childs reaction to parents attempt to
  discipline
• Mistaken Goal recognition flex smile, twinkle
• Goal recognition and disclosure

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Adlerian Family Therapy Goals

• Unlock mistaken goals and interactional patterns
• Engage parents in a learning experience and a
  collaborative assessment
• Emphasis is on the familys motivational patterns
• Main aim is to initiate a reorientation of the
  family
• Assist family member to have Social Equality- the
  sense that everyone has an equal right to be
  valued and respected in the family

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Adlerian Therapist Functioning

• Open forum
• Parent Interview alone they are leaders
• Problem Description parents concerns
• Goal Identification What did you do about it?
• Typical Day repeated patterns of interaction
• Child Interview
• Goal Disclosure Do you know why you do
• Posit tentative goals Could it be that
• Concluding Remarks to generate new approaches to
  end mistaken interactions to lead to more
  democratic, harmonious, effective living

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Multigenerational Family Therapy Outline-Murray
Bowen

• Key Concepts
• Therapy Goals
• Therapists functions

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Multigenerational Family Therapy Murray Bowen 8
Key Concepts

• The application of rational thinking to
  emotionally saturated systems. A
  well-articulated theory is considered to be
  essential
• Differentiation of the self
• Triangulation
• Nuclear Family Emotional System
• Family Projection Process
• Emotional cutoff
• Multigenerational transmission process
• Sibling position
• Societal regression

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Differentiation of the self

• A psychological separation of intellect emotion
  independence of self from others
• Differentiated Being able to be guided by
  thoughts or emotions separateness
• Undifferentiateddifficulty separating self from
  others-fuse with dominant family emotional
  patterns-physical but not emotional leaving
• Unproductive family dynamics of previous
  generation transmitted by marriage of
  undifferentiated individuals
• Need for self-identify while still belonging to
  ones family

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Triangulation

• A third party is recruited to reduce anxiety and
  stabilize a couples relationship
• Underlying conflict not addressed worsens
• Once the 3rd person is resolved the balance
  achieved is off again
• Change in one part of family system affects the
  whole system
• Therapist must be highly differentiated so as not
  to get caught up in triangulation with couple

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Multigenerational Family Therapy Goals

• With the proper knowledge the individual can
  change
• Change occurs only with other family members
• To change the individuals within the context of
  the system
• To end generation-to-generation transmission of
  problems by resolving emotional attachments
• To lessen anxiety and relieve symptoms
• To increase the individual members level of
  differentiation

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Multigenerational Family Therapy Therapist
Functioning

• Genogram work look at family over three
  generations
• Look for critical turning points in family
  emotional process
• Characteristics of family members
• Evolutional picture of family tools for
  assessment
• Asking Questions What role did you play with
  that person in the family? Looking for fusion
  within the family.

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Conjoint Family Therapy Outline

• Key Concepts
• Therapy Goals
• Therapists functions

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Conjoint Family Therapy Key Concepts-Virginia
Satir

• Enhancement and validation of self-esteem-Human
  Validation Process ModelFamily rules
• Congruence and openness in communications
• Sculpting
• Nurturing triads
• Family mapping and chronologies

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Conjoint Family Therapy Goals

• Open communications
• Individuals are allowed to honestly report their
  perceptions
• Enhancement of self-esteem
• Family decisions are based on individual needs
• Encouragement of growth
• Differences are acknowledged and seen as
  opportunities for growth
• Transform extreme rules into useful and
  functional rules
• Families have many spoken and unspoken rules

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Family Life

• Children enter pre-existing systems which have
  rules
• Rules about living interaction
• Rules governing Communications-who says what
  under what conditions
• Rules spoken and unspoken shoulds and should
  nots
• Rules become absolutes often are impossible
  Never be angry with your father. Always keep a
  smile on your face
• As child accept rules for survival which are not
  useful as adult

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Functional vs. Dysfunctional Communications

• Functional each family member give chance to be
  individual, separate life lots of freedom and
  flexibility in family with open communications
• Dysfunctional closed communications, poor
  self-esteem of parents, rigid patterns-resists
  awareness, strained relationships, little
  individuality, incapable of autonomy or genuine
  intimacy Family members think, feel and act the
  same way family controlled by fear, punishment,
  guilt or dominance

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Defensive Stances in Coping with Stress

• Placating-enabler, people pleaser, rescuer
• Blaming-troubled person
• Super-responsible-looking good
• Irrelevant behavior-distracting- acting out,
  entertainer

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Family Roles and Family Triads

• Roles played in family based on ones behavior
• Victim
• Keeping the Peace
• Stern Taskmaster
• Disciplinarian
• Hard-working caregiver
• Nurturing Triad two parents and child where child
  is nurtured

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Conjoint Family Therapy Goals

• Communicating Clearly
• Expanding awareness
• Enhancing potentials for growth in self-esteem
• Coping with demands process of change
• Identify new possibilities to the status quo
• Encouraging growth in each member
• Generating hope, courage to formulate new options
• Assess, strengthen, enhance coping skills
• Encourage members to exercise healthy options

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Therapist Functions

• Focus on emotional honesty, congruence, systemic
  understanding
• Family sculpting position family members by
  roles they play in family
• Family reconstruction psychodramtic reenactment
  significant event in 3 generations of
  family-unlock dysfunctional patterns stem from
  family of origin

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Experiential Family Therapy Outline-Carl Whitaker

• Key Concepts
• Therapy Goals
• Therapists functions
• Techniques

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Experiential Family Therapy Carl Whitaker

• A freewheeling, intuitive, sometimes outrageous
  approach aiming to
• Unmask pretense, create new meaning, and liberate
  family members to be themselves
• Techniques are secondary to the therapeutic
  relationship
• Pragmatic and atheoretical
• Interventions create turmoil and intensify what
  is going on here and now in the family

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Experiential Family Therapy Key Concepts

• Subjective Focus subjective needs of the family
  members
• Assumption all family members have a right to be
  themselves
• Needs of family may be suppressing rights of the
  individual
• Goal for authenticity, no right or wrong way to
  be

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Atheoretical Stance

• Pragmatic stance
• Theory can be hindrance to clinical work
• Often times theory is way for therapist to create
  distance from clients and control anxiety of the
  therapist to hide behind
• Intensify present experiencing of family members
  to reach unconscious to understand what is really
  going on in the family
• Process to help tap into Family secrets just
  keeping the secrets keeps the family crazy

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Experiential Family Therapy Goals

• Facilitate individual autonomy and a sense of
  belonging in the family
• Help individuals achieve more intimacy by
  increasing their awareness and their experiencing
• Encourage members to be themselves by freely
  expressing what they are thinking and feeling
• Support spontaneity, creativity, the ability to
  play, and the willingness to be crazy

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Therapist Function in Experiential Family Therapy

• Create family turmoil
• Coach family how to get out of the turmoil
• Highly involved therapist model must be
  transparent, take risks, get involved with family
  in the sessions
• Help family member experience the here and now by
  therapist BEING WITH the family
• Three phases engagement (all powerful),
  involvement (dominant parent figure, adviser)
  disentanglement (more personal, less involved)

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Structural Family Therapy Outline - Salvador
Minuchin

• Key Concepts
• Therapy Goals
• Therapists functions

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Structural Family Therapy - Salvador Minuchin

• Focus is on family interactions to understand the
  structure, or organization of the family
• Symptoms are a by-product of structural failings
• Structural changes must occur in a family before
  an individuals symptoms can be reduced
• Techniques are active, directive, and well
  thought-out
• Focus on the how, when, and to whom family
  members relate

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Key Concepts Structural Family Therapy of
Salvador Minuchin

• Family Structure invisible set of functional
  demands or rules that organize way family members
  relate to one another-
• Observe family to see the structure
• who says what to whom,
• in what way,
• with what result

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Family Subsystems

• Spousal wife husband
• Parental mother father
• Sibling children
• Extended grandparents, other relatives
• Family member play a different role in each of
  the subsystems they belong
• Structural difficulty when one subsystem takes
  over or intrude another

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Boundaries

• Emotional barriers that protect enhance the
  integrity of individuals, subsytems families
• Extremes of boundaries
• Disengagement-overly detached-rigid
• Enmeshment-very involved as one-diffuse-fosters
  dependency on parents
• Clear healthy boundaries-attain sense of personal
  identity yet allow sense of belongingness within
  family system

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Structural Family Therapy Goals

• Reduce symptoms of dysfunction
• Bring about structural change by
• Modifying the familys transactional rules
• Developing more appropriate boundaries
• Creation of an effective hierarchical structure
• It is assumed that faulty family structures have
• Boundaries that are rigid or diffuse
• Subsystems that have inappropriate tasks and
  functions

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Structural Family Therapist Function

• To actively engage family as unit to initiate
  structural change by
• Joining the family in a position of leadership
• Mapping its underlying structure
• Intervening in ways designed to transform an
  ineffective structure
• The Therapeutic Endeavor is challenging rigid
  transactional patterns
• Pushing for clearer boundaries
• Increasing degree of flexibility in family
  interactions
• Modifying dysfunctional family structures

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Structural Family Techniques

• Joining build maintain therapeutic alliance
  with family
• Family Mapping draw map to identify boundaries ,
  transactional styles
• Enactments family engages in conflict situation
  that would happen at home
• Reframing new light or different interpretation
  on problem situation in family

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Strategic Family Therapy Outline

• Key Concepts
• Therapy Goals
• Therapists functions

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Strategic Family Therapy Key Concepts

• Focuses on solving problems in the present
• Presenting problems are accepted as real and
  not a symptom of system dysfunction
• Therapy is brief, process-focused, and
  solution-oriented
• The therapist designs strategies for change
• Change results when the family follows the
  therapists directions and change transactions

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Strategic Family Therapy Goals

• Resolve presenting problems by focusing on
  behavioral sequences
• Get people to behave differently
• Shift the family organization so that the
  presenting problem is no longer functional
• Move the family toward the appropriate stage of
  family development
• Problems often arise during the transition from
  one developmental stage to the next

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Strategic Family Therapists Function

• Therapist consultant, expert, stage
  director-change is therapists responsibility
• Use of Directives designed to change the system
  advice, suggestions, coaching, giving
  ordeal-therapy assignment
• Paradoxical Interventions exaggerate or perfect
  a problematic behavior
• Reframing reinterpreting problematic behaviors
  which are entrenched-giving new meaning to
  behaviors may produce new behaviors that fit the
  new interpretation

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Social Constructionism

• The client, not the therapist, is the expert
• Dialogue is used to elicit perspective,
  resources, and unique client experiences
• Questions empower family members to speak, and to
  express their diverse positions
• The therapist supplies optimism and the process

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Social Constructionism Therapy Goals

• Generate new meaning in the lives of family
  members
• Co-develop, with families, solutions that are
  unique to the situation
• Enhance awareness of the impact of various
  aspects of the dominant culture on the family
• Help families develop alternative ways of being,
  acting, knowing, and living