Orientation to Family Therapy

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Orientation to Family Therapy

• PSY 660, Dr. Katz
• Presented by Alyssa Rylander

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Group Therapy

• Group dynamics are relevant to family therapy
  because group life is a complex bind of
  individual personalities and superordinate
  properties of the group
• Process vs. content of messages
• Listening to how families talk as to the content
  of their discussions
• Expectations that roles carry bring regularity to
  complex social situations

3
Child-Guidance Movement

• Blamed parents for psychological problems in
  children
• Schizophrenogenic Mother
• Family was emphasized, but mother and child
  treated separately
• Interaction between parent child problem
• John Bowlby (1949)
• Family meetings adjunct to real treatment only if
  (11) therapy was not going anywhere

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Influence of Social Work

• Saw family as the critical social unit and focus
  of intervention
• Families must be considered as units
• 1917 Mary Richmond, Social Diagnosis
• Treatment of the whole family and warned against
  isolating family members from their natural
  context
• The degree of emotional bonding between family
  members was critical to their ability to survive
  and flourish
• Once family therapy movement was launched, social
  workers were one of most important contributors

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Role of Schizophrenia in Family Therapy

• Researchers drawn to families with schizophrenic
  members because of their patterns of interaction
• Never actually conducted family therapy sessions,
  but observed the families patterns of
  interactions/communication
• 1927 Harry Stack Sullivan
• hospital family hospital staff substituted
  patients real family

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Role of Schizophrenia in Family Therapy

• Freida Fromm-Reichmann also believed in the
  hospital family however treated the real
  family as an environment from which the patient
  must be removed
• 1940s 1950s research on the link between
  family life and schizophrenia led to the work of
  early family therapists

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Research on Family Dynamics

• Gregory Bateson (Palo Alto)
• 1952 Grant to study the nature of communication
  in terms of levels
• Two levels of communication Report and command
• Metacommunication convert and often goes
  unnoticed
• 1954 Grant to study schizophrenic communication
• Group turned to developing a communication theory
  that might explain origin and nature of
  schizophrenic behavior, particularly in the
  context of families
• Never actually thought about observing families
• Homeostasis
• Double bind

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Research on Family Dynamics

• Theodore Lidz - Yale
• 5 patterns of pathological fathering
• Defects in marital relationships
• Role reciprocity balancing your role with your
  partners
• Marital schism failure to achieve role
  reciprocity
• Marital skew serious psychopathology in one
  partner dominates the other
• Saw father as weaker partner/spouse
• Unhappy children were torn by conflicting
  loyalties and weighted down by trying to balance
  their parents marriage

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Research on Family Dynamics

• Lyman Wynne - NIMH
• 1952 Examined the effects of communication and
  family roles, but focused on how pathological
  thinking is transmitted in families
• Joined by Murray Bowen at NIMH
• Both shared belief that family should be unit of
  treatment
• 1954 started seeing parents of schizophrenics
  twice-weekly
• Pseudomutuality, pseudohostility, rubber fence
• Saw schizophrenic family as a sick little society
  by itself

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Research on Family Dynamics

• John Spiegel (Role Theorist)
• Described how individuals were differentiated
  into social roles within family systems
• 1951 GAP Committee formed
• Research emphasized roles as primary structural
  components of families
• Every role has a reciprocal role
• Explained that roles serve as a link between
  intrapersonal and interpersonal structures
• Spiegel described observations in psychoanalytic
  terms children identify with unconscious wishes
  of parents and act our their emotional conflict.
• R.D. Laing (1965) mystification

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Research on Family Dynamics

• Bela Mittleman
• 1948 first account of concurrent marital therapy
• Saw that it was possible to reexamine their
  irrational perceptions of each other
• Without insight, unconscious motivation may
  dominate marital behavior, leading to reciprocal
  neurotic actions and reactions
• Believed that 20 of the time one therapist could
  handle all family members, but in other cases
  separate therapists would for each member would
  be better
• Couples therapy allows for more in-depth focus on
  the psychology of the individuals than family
  therapy does.

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Pioneers of Family Therapy

• John Bell
• Began treating families in 1951
• Family group therapy relied primarily on
  stimulating an open discussion to help families
  solve their problems
• Acted as a group therapist, intervening to have
  others speak up and interpreted reasons for
  defensiveness
• Structured treatment in a series of stages
• Later became less directive and allowed families
  to evolve

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Pioneers of Family Therapy

• Palo Alto (Bateson Group)
• Don Jackson (1954)
• Family homeostasis families are units that
  resist change
• Patients symptoms preserve stability in their
  families
• Behavioral redundancy all people in continuing
  relationships develop set patterns of interaction
• Made an effort to develop a language of family
  interactions, but focused primarily on spousal
  relationships thus ignoring children in treatment

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Pioneers of Family Therapy

• Palo Alto (Bateson Group)
• Jay Haley (1963)
• Explored how covert messages are used in the
  struggle for control in relationships
• Symptoms represent an incongruence between levels
  of communication
• Brief therapy zeroing in on the context and
  possible function of the patients symptoms
• Coalitions cooperative arrangements between two
  parties, not formed at the expense of the third.
• Most coalitions were cross-generational (one
  parent ganging up with the child against the
  other parent)

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Pioneers of Family Therapy

• Palo Alto (Bateson Group)
• Virginia Satir
• Saw troubled family members as trapped in narrow
  family roles that constrained relationships and
  sapped self-esteem
• Major focus was always on the individual
• Concentrated on clarifying communication,
  expressing feelings, and fostering a climate of
  mutual acceptance and warmth
• Known for turning negatives into positives
• 1964 publication of Conjoint Family Therapy

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Pioneers of Family Therapy

• Murray Bowen (NIMH)
• Hospitalize whole families with schizophrenic
  members (included role of fathers) and led to the
  concept of triangles
• Separate therapists for individual family members
• 1955 began holding large group therapy sessions
  for the entire project staff and all the families
• Therapists pull in different directions ? put one
  therapist in charge and put the others in
  supporting roles ? families pull in different
  directions ? families had to take turns
• As therapist, he would just try to get families
  to talk ? soon realized unstructured family chats
  were very unproductive
• Emotional reactivity
• Had family members speak to the therapist instead
  of directly to each other

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Pioneers of Family Therapy

• Nathan Ackerman
• Always concerned with what goes on inside people
  as well as between them
• Never lost sight of self in the system
• Role as therapist was to stir things up and bring
  family secrets into the open
• Became emotionally involved with families
• Carl Whitaker
• Pioneered use of cotherapy, freeing therapists to
  react spontaneously without fear of
  countertransference
• Eschewed theory in favor of creative spontaneity
• Created tension by teasing stress necessary for
  change

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Pioneers of Family Therapy

• Ivan Boszormenyi-Nagy
• Network therapy as may people as possible
  invited to therapy session to help support
  patient change
• Added ethical accountability to therapeutic goals
  and techniques
• Salvador Minuchin
• 1960s family problems are resistant to change
  becase theyre embedded in powerful but unseen
  structures (structural family therapy)
• Enmeshed chaotic and tightly connected
• Disengaged isolated and seemingly related
• First and second order change

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Structural Family Therapy

• Therapist must accommodate family in order to
  join them
• Start by trying to understand family instead of
  challenging their preferred mode of relating
• Use restructuring techniques active maneuvers to
  disrupt dysfunctional structures by strengthening
  diffuse boundaries and loosening rigid ones.

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Family Therapy

• 1960s Look at this!
• 1970s Look what I can do!
• 1970-1985 development of famous schools of
  family therapy as the pioneers established
  training centers and worked out the implications
  in their models
• Structural therapy proved to be most influential,
  providing a simple yet meaningful way of
  describing family organization and a set of easy
  to follow steps to treatment

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Discussion Questions

• Why did the pioneering psychologists, trained in
  psychoanalysis, ignore the individual in the
  beginning stages of family therapy?
• What is it about Schizophrenia that encouraged
  research and eventually led to a systems
  approach? Do you think it was a good starting
  point?
• What do role reciprocation, homeostasis, double
  bind rubber fence, mystification, and coalitions
  all have in common? Why do you think there was
  such a recurring theme throughout research?