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Chapter 16: Group and Family Therapy (Family Therapy (The system as the…
Chapter 16: Group and Family Therapy
Group Therapy
Interpersonal Emphasis
Group therapy: adaptations of well-known individual therapy approaches
Interpersonal Interaction: the therapy emphasizes the experiences of individuals as they interact with other people
therapists highlight the way group members feel, communicate and form relationships with one another
Irvin Yalom: leading figure in interpersonal approach to group therapy
argues that all psychological problems stem from flawed interpersonal relationships; a problem is a byproduct of his or her disturbed way of getting along with other people
Therapeutic factors in group therapy
Universality: uplifting feeling of being in a room full of other people who have similar problems- built into homogeneous groups
Instillation of hope
imparting information
Altruism
Corrective recapitulation of the primary family group
Development of socializing techniques
Imitative behavior
Interpersonal learning: learning from the in-group interpersonal experience; at the heart of group therapy; gives members opportunity for relationship practice
Group cohesiveness: the feelings of interconnectedness among group members
Catharsis
Existential factors
Social microcosm: relationship tendencies that characterize relationships in personal lives will also characterize relationships in the group
The here and now: therapist steers clients to examine relationships among group members rather than what happens outside the context of the group; promoting interaction and reflection/discussion
Practical Issues in Group Therapy
Group membership
Open-enrollment groups: allow individual members to enter or leave the group at any time
Closed-enrollment groups: all members start and finish therapy together
Preparing clients for group therapy: necessary to correct misconceptions and maximize therapeutic benefit
Developmental stages of therapy groups: clients in beginning stages are cautious about acceptance, then conflict occurs and eventually there is cohesiveness as the group sessions become more consistently productive
Cotherapists
Advantages: second set of eye/ears to notice communication, ability to model collaborative relationships, recapitulation of the family group
Pitfalls: distrust/competition between therapists, incompatible therapy orientations
Socializing between clients: extra-group socializing- loyalty to relationships may be greater than the loyalty to the group which can inhibit purpose of group-based relationships
Ethical Issues in Group Therapy
Confidentiality: possibility that fellow group members may violate a clients confidentiality; not a problem for therapist due to professional and ethical standards
Family Therapy
The system as the problem
Systems approach: the whole is more than the sum of the parts
Linear causality: events from the past cause or determine events in the present in a unidirectional manner
Circular causality: events influence one another in a reciprocal way; regardless of the original cause of a problem, it is maintained over time
Communication patterns: the type of interaction that most significantly contributes to psychological problems
Functionalism: although psychological symptoms may appear maladaptive, they are functional within the individual's family environment
Homeostasis: systems have the ability to regulate themselves by returning themselves to a comfort zone or "set point"
leaders believed that psychological symptoms were a byproduct of the dysfunctional families in which the clients lived
Feedback: actions that family members do to bring the family back if they detect that the family is straying from their emotional or behavioral comfort zone
Assessment of Families
Assessment typically focuses on issues such as defining the presenting problem, understanding family members' beliefs about its causes and appreciating the relationships within the family
Genogram: pencil-and-paper method of creating a family tree that incorporates detailed information about the relationships among family members for at least three generations
Family life cycle
Leaving home: single young adults become independent and self-sufficient
Joining families through marriage or union: a new couple forms a new family system and the spouse is incorporated into existing family systems
Families with young children: taking care of children, adjusting the marriage and managing child-related, financial and other responsibilities
Families with adolescents: parents provide children with increasing amounts of independence
Launching children and moving on in midlife: empty next, relationships with children's partners, taking on the grandparent role
Families in late middle age: managing declining health and adapting to new roles
Families nearing the end of life: accepting the realities and inevitability of death and reversing caretaker roles
Conflict tactics scale (CTS): structured way of assessing abuse and violence within families
Identified patient: family member whose symptoms are most obvious or problematic
Essential Concepts
Ahistorical styles: emphasizing current functioning and deemphasizing family history
Historical styles: emphasizing family history and longer in duration than ahistorical styles
Experiential styles:emphasizing personal growth and emotional experiencing in and out of sessions
Classic concepts
Family structure: rules by which the family operates
Differentiation of self: healthy families allow each member to become his or her own person without sacrificing emotional closeness with other members of the family
Triangles: parents at odds and a child recruited to side with one parent
Contemporary approaches
Solution-focused therapy: discussing positive outcomes that the future may hold rather than unpleasant situations that characterize the present
Narrative therapy: highlights clients' tendencies to create meanings about themselves and the evens in their lives in particular ways, some of which may cause psychological problems
Multisystemic family therapy: designed for adolescents with long-term behavioral and emotional problems that involve legal offenses
Ethical issues
Cultural competence: full appreciation of and acceptance for the cultural background of the families with whom they work
Confidentiality: set ground rules for confidentiality during the initial informed consent process; therapist must remember from whom they received information
Diagnostic accuracy: DSM contains no diagnostic labels that apply to families- may create problems when reimbursement needs to happen