Family Therapy

1
Family Therapy

• http//www.youtube.com/watch?v9PU-hTdkzg8

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Two Focuses

• The first is togetherness and the second is
  individuality.
• Too much togetherness creates fusion and prevents
  individuality, or developing one's own sense of
  self.
• Too much individuality results in a distant and
  estranged family.

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Differentiation of Self

• The first concept is Differentiation of Self, or
  the ability to separate feelings and thoughts.
  Undifferentiated people can not separate feelings
  and thoughts when asked to think, they are
  flooded with feelings, and have difficulty
  thinking logically and basing their responses on
  that. Further, they have difficulty separating
  their own from other's feelings they look to
  family to define how they think about issues,
  feel about people, and interpret their
  experiences.Differentiation is the process of
  freeing yourself from your family's processes to
  define yourself. This means being able to have
  different opinions and values than your family
  members, but being able to stay emotionally
  connected to them. It means being able to calmly
  reflect on a conflicted interaction afterward,
  realizing your own role in it, and then choosing
  a different response for the future.

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Triangles

• Triangles are the basic units of systems. Dyads
  are inherently unstable, as two people will
  vacillate between closeness and distance. When
  distressed or feeling intense emotions, they will
  seek a third person to triangulate.
• Think about a couple who has an argument, and
  afterward, one of the partners calls their parent
  or best friend to talk about the fight. The third
  person helps them reduce their anxiety and take
  action, or calm their strong emotions and
  reflect, or bolster their beliefs and make a
  decision.
• This is a healthy triangulation!

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Triangles

• People who are more undifferentiated are likely
  to triangulate others and be triangulated. People
  who are differentiated cope well with life and
  relationship stress, and thus are less likely to
  triangulate others or be triangulated.
• Think of the person who can listen to the best
  friend's relationship problems without telling
  the friend what to do or only validating the
  friend's view. Instead, the differentiated person
  can tell the best friend "You know, you can be
  intimidating at those times..." or "I agree with
  you but you won't change your partner you either
  have to learn to accept this about them, or have
  to call this relationship quits...
• http//www.youtube.com/watch?vnAvspf49UTE

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The Nuclear Family Emotional Processes

• These are the emotional patterns in a family that
  continue over the generations.
• Think about a mother who lived through The Great
  Depression, and taught her daughter to always
  prepare for the worst case scenario and be happy
  simply if things are not that bad. The daughter
  thinks her mother is wise, and so adopts this way
  of thinking. She grows up, has a son, and without
  realizing it, models this way of thinking. He may
  follow or reject it, and whether he has a happy
  or distressed relationship may depend on the kind
  of partner he finds.
• http//www.youtube.com/watch?v4fC6x8paqpc

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Emotional Process

• Likewise, think of a daughter who goes to work
  for her father, who built his own father's small
  struggling business into a thriving company. He
  is seen in the family as a great business person
  as he did this by taking risks in a time of great
  economic opportunity. He teaches his daughter to
  take risks, "spend money to make money," and
  assume a great idea will always be profitable.
  His daughter may follow or reject her father's
  advice, and her success will depend on whether
  she faces an economic boom or recession.

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Emotional Process

• In both cases, the parent passes on an emotional
  view of the world (the emotional process), which
  is taught each generation from parent to child,
  the smallest possible "unit" of family (the
  nuclear unit). Reactions to this process can
  range from open conflict, to physical or
  emotional problems in one family member, to
  reactive distancing (see below). Problems with
  family members may include things like substance
  abuse, irresponsibility, depression....
• http//www.youtube.com/watch?v0Bgshe4S3_s

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The Family Projection Process

• This is an extension of The Nuclear Family
  Emotional Process in many ways.
• The family member who "has" the "problem" is
  triangulated and serves to stabilize a dyad in
  the family.

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Family Projection Process

• Thus, the son who rejects his mother's
  pessimistic view may find his mother and sister
  become closer, as they agree that he is immature
  and irresponsible. The more they share this view
  with him, the more it makes him feel excluded and
  shapes how he sees himself. He may act in accord
  with this view and behave more and more
  irresponsibly. He may reject it, constantly
  trying to "prove" himself to be mature and
  responsible, but failing to gain his family's
  approval because they do not attribute his
  successes to his own abilities ("He was so lucky
  that his company had a job opening when he
  applied..." or "It's a good thing the loan
  officer felt sorry for him because he couldn't
  have managed it without that loan..."). He might
  turn to substance abuse as he becomes more and
  more irresponsible, or as he struggles with never
  meeting his family's expectations.

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Family Projection Process

• Similarly, the daughter who faces harsh economic
  times and is more fiscally conservative than her
  father is seen by the parents as too rigid and
  dull. They join together to worry that she'll
  never be happily married. She might accept this
  role and become a workaholic who has only
  superficial relationships, or reject it and take
  wild risks that fail. In the end, she may become
  depressed as she works more and more, or as she
  fails to live up to her father's reputation as a
  creative and successful business person.

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Family Projection Process

• The family member who serves as the "screen" upon
  which the family "projects" this story will have
  great trouble differentiating. It will be hard
  for the son or daughter above to hold their own
  opinions and values, maintain their emotional
  strength, and make their own choices freely
  despite the family's view of them.

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The Multigenerational Transmission Process

• This process entails the way family emotional
  processes are transferred and maintained over the
  generations. This captures how the whole family
  joins in The Family Projection Process, for
  example, by reinforcing the beliefs of the
  family. As the family continues this pattern over
  generations, they also refer back to previous
  generations ("He's just like his Uncle Albert -
  he was always irresponsible too" or "She's just
  like your cousin Jenny - she was divorced four
  times.").

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Sibling Position

• sibling order, believing that each child had a
  place in the family hierarchy, and thus was more
  or less likely to fit some projections. The
  oldest sibling was more likely to be seen as
  overly responsible and mature, and the youngest
  as overly irresponsible and immature for example.
  
• Think of the oldest sibling who grows up and
  partners with a person who was also an oldest
  sibling. They may be drawn to each other because
  both believe the other is mature and responsible.
• Alternately, an oldest sibling might have a
  relationship with someone who was a youngest
  sibling. When one partner behaves a certain way,
  the other might think "This is exactly how my
  older/younger sibling used to act."

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Emotional Cutoff

• This refers to an extreme response to The Family
  Projection Process. This entails a complete or
  almost-complete separation from the family. The
  person will have little, if any, contact, and may
  look and feel completely independent from the
  family. However, people who cut off their family
  are more likely to repeat the emotional and
  behavioral patterns they were taught.

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• In some cases, they model the same values and
  coping patterns in their adult family that they
  were taught in their childhood family without
  realizing it. They do not have another internal
  model for how families live, and so it is very
  hard to "do something different." Thus, some
  parents from emotionally constrained families may
  resent how they were raised, but they do not know
  how to be "emotionally free" and raise a family
  as they believe other families would.

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• In other cases, they consciously attempt to be
  very different as parents and partners however,
  they fail to realize the adaptive characteristics
  of their family and role models, as well as the
  compensatory roles played in a complex family.
  Thus, some parents from emotionally constrained
  childhood families might discover ways to be
  "emotionally unrestrained" in their adult
  families, but may not recognize some of the
  problems associated with being so emotionally
  unrestrained, or the benefits of being
  emotionally constrained in some cases. Because of
  this, Bowen believed that people tend to seek out
  partners who are at about the same level of
  individuation.

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Normal Family Development

• optimal family development occurs when family
  members are differentiated, feel little anxiety
  regarding the family, and maintain a rewarding
  and healthy emotional contact with each other.

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• are balanced in terms of their togetherness and
  separateness, and can adapt to changes in the
  environment
• view emotional problems as coming largely from
  the greater system but as having some components
  in the individual member
• are connected across generations to extended
  family
• have little emotional fusion and distance
• have dyads that can deal with problems between
  them without pulling others into their
  difficulties
• tolerate and support members who have different
  values and feelings, and thus can support
  differentiation
• are aware of influences from outside the family
  (such as Societal Emotional Processes) as well as
  from within the family
• allow each member to have their own emptiness and
  periods of pain, without rushing to resolve or
  protect them from the pain and thus prohibit
  growth
• preserve a positive emotional climate, and thus
  have members who believe the family is a good one
  
• have members who use each other for feedback and
  support rather than for emotional crutches

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Family Disorders

• family problems result from emotional fusion, or
  from an increase in the level of anxiety in the
  family. Typically, the member with "the symptom"
  is the least differentiated member of the family,
  and thus the one who has the least ability to
  resist the pull to become fused with another
  member, or who has the least ability to separate
  their own thoughts and feelings from those of the
  larger family. The member "absorbs" the anxiety
  and worries of the whole family and becomes the
  most debilitated by these feelings. Families face
  two kinds of problems.

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• Vertical problems are "passed down" from parent
  to child. Thus, adults who had cold and distant
  relationships with their parents do not know how
  to have warm and close relationships with their
  children, and so pass down their own problems to
  their children.
• Horizontal problems are caused by environmental
  stressors or transition points in the family
  development. This may result from traumas such as
  a chronic illness, the loss of the family home,
  or the death of a family member. However,
  horizontal stress may also result from Social
  Emotional Processes, such as when a minority
  family moves from a like-minority neighborhood to
  a very different neighborhood, or when a family
  with traditional gender roles immigrates to a
  culture with very different views, and must raise
  their children there. The worst case for the
  family is when vertical and horizontal problems
  happen at once.

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• The basic roles which I list below apply to
  American culture specifically, and Western
  Civilization generally - but with a few changes
  in details could be made to fit most any culture.
  
• There are four basic roles that children adopt in
  order to survive growing up in emotionally
  dishonest, shame-based, dysfunctional family
  systems.  Some children maintain one role into
  adulthood while others switch from one role to
  another as the family dynamic changes (i.e. when
  the oldest leaves home, etc.)  An only child may
  play all of the roles at one time or another.  

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"Responsible Child" - "Family Hero"

• This is the child who is "9 going on 40."  This
  child takes over the parent role at a very young
  age, becoming very responsible and
  self-sufficient.  They give the family self-worth
  because they look good on the outside.  They are
  the good students, the sports stars, the prom
  queens.  The parents look to this child to prove
  that they are good parents and good people. As an
  adult the Family Hero is rigid, controlling, and
  extremely judgmental (although perhaps very
  subtle about it) - of others and secretly of
  themselves.  They achieve "success" on the
  outside and get lots of positive attention but
  are cut off from their inner emotional life, from
  their True Self.  They are compulsive and driven
  as adults because deep inside they feel
  inadequate and insecure.
• The family hero, because of their "success" in
  conforming to dysfunctional cultural definitions
  of what constitutes doing life "right", is often
  the child in the family who as an adult has the
  hardest time even admitting that there is
  anything within themselves that needs to be
  healed.

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"Acting out child" - "Scapegoat"

• This is the child that the family feels ashamed
  of - and the most emotionally honest child in the
  family.  He/she acts out the tension and anger
  the family ignores.  This child provides
  distraction from the real issues in the family. 
  The scapegoat usually has trouble in school
  because they get attention the only way they know
  how - which is negatively.  They often become
  pregnant or addicted as teenagers. These children
  are usually the most sensitive and caring which
  is why they feel such tremendous hurt.  They are
  romantics who become very cynical and
  distrustful.  They have a lot of self-hatred and
  can be very self-destructive.  This often results
  in this child becoming the first person in the
  family to get into some kind of recovery.

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"Placater" - "Mascot" - "Caretaker"

• This child takes responsibility for the emotional
  well-being of the family.  They become the
  families 'social director' and/or clown,
  diverting the family's attention from the pain
  and anger. This child becomes an adult who is
  valued for their kind heart, generosity, and
  ability to listen to others.  Their whole
  self-definition is centered on others and they
  don't know how to get their own needs met.  They
  become adults who cannot receive love, only give
  it.  They often have case loads rather than
  friendships - and get involved in abusive
  relationships in an attempt to "save" the other
  person.  They go into the helping professions and
  become nurses, and social workers, and
  therapists.  They have very low self-worth and
  feel a lot of guilt that they work very hard to
  overcome by being really "nice" (i.e. people
  pleasing, classically codependent) people.

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"Adjuster" - "Lost Child"

• This child escapes by attempting to be
  invisible.  They daydream, fantasize, read a lot
  of books or watch a lot of TV. They deal with
  reality by withdrawing from it.  They deny that
  they have any feelings and "don't bother getting
  upset." These children grow up to be adults who
  find themselves unable to feel and suffer very
  low self-esteem.  They are terrified of intimacy
  and often have relationship phobia.  They are
  very withdrawn and shy and become socially
  isolated because that is the only way they know
  to be safe from being hurt.  A lot of actors and
  writers are 'lost children' who have found a way
  to express emotions while hiding behind their
  characters.

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• It is important to note that we adapt the roles
  that are best suited to our personalities.  We
  are, of course, born with a certain personality. 
  What happens with the roles we adapt in our
  family dynamic is that we get a twisted,
  distorted view of who we are as a result of our
  personality melding with the roles. This is
  dysfunctional because it causes us to not be able
  to see ourselves clearly.  As long as we are
  still reacting to our childhood wounding and old
  tapes then we cannot get in touch clearly with
  who we really are. 

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• The false self that we develop to survive is
  never totally false - there is always some Truth
  in it.  For example, people who go into the
  helping professions do truly care and are not
  doing what they do simply out of Codependence. 
  Nothing is black and white - everything in life
  involves various shades of gray.  Recovery is
  about getting honest with ourselves and finding
  some balance in our life.   Recovery is about
  seeing ourselves more clearly and honestly so
  that we can start being True to who we really are
  instead of to who our parents wanted us to be. 
  (Reacting to the other extreme by rebelling
  against who they wanted us to be is still living
  life in reaction to our childhoods. It is still
  giving power over how we live our life to the
  past instead of seeing clearly so that we can own
  our choices today.) The clearer we can see our
  self the easier it becomes to find some balance
  in our life - to find some happiness,
  fulfillment, and serenity.

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Goals of Therapy

• reframing the presenting problem as a
  multigenerational problem that is caused by
  factors beyond the individual
• lowering anxiety and the "emotional turmoil" that
  floods the family so they can reflect and act
  more calmly
• increasing differentiation (individuality),
  especially of the co-dependent, so as to increase
  their ability to manage their own anxiety,
  transition more effectively into a healthy
  relationship with the addict, and thus fortify
  (strengthen) the entire family unit's emotional
  wellbeing
• using the therapist as part of a "healthy
  triangle" where the therapist teaches the family
  to manage their own anxiety, create distance and
  closeness in healthy ways
• focusing away from "the problem" and including
  the overall health and happiness of the family.
  Thus creating positive habits and interests
• evaluating the progress of the family in terms of
  how they function now compared to when they
  started, as well as how adaptive they can be to
  future changes
• addressing the power differential in families
  such as economic power and gender role
  socialization.

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• In general, the therapist accomplishes this by
  giving less attention to specific problem they
  present with, and more attention to family
  patterns of emotions and relationships, as well
  as family structures of dyads and triangles.
• tries to lower anxiety to promote understanding,
  which is the critical factor in change open
  conflict is prohibited as it raises the family
  members' anxiety during future sessions
• remains neutral and detriangulated, and in effect
  models for the parents some of what they must do
  for the family
• promotes separation of members, as often a single
  member can cause changes in the larger family
  using "I" statements is one way to help family
  members separate their own emotions and thoughts
  from those of the rest of the family
• develops a personal relationships with each
  member of the family and encourages family
  members to form stronger relationships too
• encourages cut off members to return to the
  family
• may use descriptive labels like "pursuer
  (co-dependent)-distancer (addict)," and help
  members see the dynamics occurring following
  distancers only causes them to run further away,
  while working with the pursuer to create a safe
  place in the relationship invites the distancer
  back.
• coaches and consults with the family, interrupts
  arguments, and models skills..

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Techniques Getting the environment right 

•  Counseling techniques   
• create a space to talk which is private and quiet
  and where you know you will be free from
  interruptions (always seek the advice of a
  colleague about the safety and appropriateness of
  this action).  Where possible, make sure the
  seating is comfortable and make sure that there
  is appropriate heating and ventilation.
• Get the message across that you have time to
  attend to the issue that you want to address.
   Get the message across that the conversation is
  private and that you will not be passing on what
  the family says to any third party.
• You have to also make it clear that if the
  family gives you information that suggests that
  they or others are in danger (for example a
  disclosure of abuse or threat of self-harm) you
  cannot keep this confidential.  Make sure that
  you are fully aware of your organisations child
  protection policies

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Getting the listening right 

• One way of encouraging a person/persons to talk
  is to make sure that they know you are listening.
   
• You can do this by just being attentive and by
  showing with your body language that you are
  listening.  
• Sometimes this will be by facing the person and
  making good eye contact.  
• Sometimes sitting side by side will be less
  threatening.  Try not to interrupt when the
  person is talking. 
• By occasionally nodding or quietly saying "yes"
  or "aha" the person should be encouraged to open
  up. 
• Reporting back to the person/family a short
  summary of what they have just said and asking
  them if you have got it right is another way of
  doing this. 
• Make sure you look and sound calm, unhurried and
  caring.

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Reflective Listening

• S "I'm very depressed today, Doctor."D "You're
  very depressed, Mr. Smith."S "Yes. I haven't
  been this depressed in a long time."D "You
  haven't been this depressed in a long time."S
  "I'm so depressed that I'm thinking about killing
  myself."D "You're thinking about killing
  yourself."S "I'd like to kill myself right
  now."D "You'd like to kill yourself right
  now."S "Yes, I'm so desperate that I think I'll
  open this window and jump out."D "You're
  thinking of jumping out that window."S "I'm
  gonna do it. See? I'm opening the window.... and
  I'm gonna jump."D "You're going to jump out the
  window."S "Bye, doc. Here I go........
  aaaaaaaaaaaaaaaaaaaaah" (splat)D
  "Aaaaaaaaaaaaaaaaaaaaaah, splat."

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Asking the right questions 

• Try to ask more open questions than closed
  questions.
• An open question is one which cannot be answered
  with yes or no and which encourages a more
  detailed answer, for example
• What are your feelings about this?
• What are the advantages of doing things the way
  you have suggested?
• What are the disadvantages?
• Avoid closed questions such as
• Are you sad?
• Are you looking forward to the holidays?
• Another disadvantage of closed questioning is
  that the desired answer might be implied within
  the question and you might inadvertently steer
  the person to give an answer that they wouldnt
  otherwise have given.  An example of this would
  be
• Are you going to stop obsessing about your
  addicted family member because it is upsetting
  you so much?
• The implied expected answer here is quite clearly
  yes.

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Being affirming   

• To encourage the flow of conversation it is
  important that you show respect by taking an
  accepting attitude. 
• The message you are trying to get across is "I
  have respect for your opinions and your view of
  the world at this present time". 
• This is not the same as saying that you agree
  with the clients opinions or actions and it is
  okay for you to make it clear that your opinions
  and moral view are different, as long as this is
  done in a respectful way.

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How to make it work

• Do not turn your conversation into an
  interrogation.  
• However good you are at counseling some people
  will not be ready to talk to you or want to talk
  to you.  
• This does not mean that you have failed.  It
  might be that they will talk later or that they
  will talk to a colleague of yours who they know
  better or a colleague of the opposite sex.  

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• http//www.youtube.com/watch?vAQ4Pktv4-Gc
• http//www.youtube.com/watch?v8-1L5WclNTg
• http//www.youtube.com/watch?viB1ZZ6Bh4GM
• http//www.youtube.com/watch?vfF-11ulCPTE