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FAMILY AND GROUP THERAPIES 1 - Coggle Diagram
FAMILY AND GROUP THERAPIES
1
Foundation of Family Therapies
Mainly based on:
Cybernetic Theory
Negative
Feedback Loop: resist change, maintain status quo.
Positive
Feedback Loop: amplify change,
disrupt
status quo
General Systems Theory
biology-approach;
predicts
all systems consist of interacting components, goverened by same general rules and have
homeostatic mechanisms
help maintain state of stability and equilibrium
Also influenced by
Postmodernism:
Challenges premises of General Systems Theoery, mainly the premise of universal governing laws
Rather use:
Constructivist / Social Constructivist Perspective
Multiple
viewpoints and realities
View family therapy as
shared
process; therapist forms
collaborative
relationship; help members ID
alternative
ways of interpreting / resolving problems
Bateson and Colleagues ALSO proposed:
Communication Theory
repetitive patterns
of communication / interaction produce problematic behavior; Problems occur when interactions btwn family members are exclusively symmetrical or complementary
Symmetrical Interactions
reflect
equality
one behavior elicits a similar behavior; Can escalate into
"one-upmanship game"
Complementary Interactions
Inequality
; behavior of one person complements behavior of the other person; Commonly, one is dominant, other is subordinate
Linked schizophrenia to
Double-Bind Communication
person receives two contradictory messages from a family member and isn't allowed to comment on the contradiction
Extended Family Systems Therapy (Bowen)
-- "Chinese Extended Family"
Key presmise:
Intergenerational and Transgenerational
Derived from work with children with schizophrenia and their families --> transmission of certain emo processes from one generation to next is
responsible
for development of schizo in one member
Key Terms:
Differentiation
Intra personal
: distinguish between their own feelings / thoughts --
separate
from own functioning and others
Inter personal:
when
low
becomes
"Emotionally Fused"
with other family members
Emotional Triangles
when there's tension between family dyad (e.g., spouses), they may
recruit
a third family member to
alleviate
the tension and
increase stability
e.g., husband and wife become overinvolved wiht one of their children
likelihood of EMO TRIANGLE developing increases as differentiation decreases.
Family Projection Process
Parents' projection of their
emo immaturity
onto their children --> children have
lower differentiation
Multigenerational Transmission Process
projection of emo immaturity from one generation to next
occurs when child most involved in family's emotional system becomes least differentiated of all kids, then as an adult, they chose a spouse with similar level of differentiation
this couple transmits even lower differentiation to one of its children. Process continues in subsequent generations and results in
severe symptoms
in a child.
*Practice
increasing differentiation in one family member facilitates this in other members
often only treat two members (usually parents) OR one member
most likely to increase differentiation
Primary Goal
increase each member's differentiation
Strategies:
1st:
Genogram
- 3 generations
Questions
: that diffuse emotions; ID contributions to problems
Teach
: how to interact with families-of-origin in ways that alter triangulated relationships
Therapist's role:
Coach
Connected but neutral (avoid involvement in fam's emo processes
to reduce Emotional Reactivity, direct members to talk directly to therapist rather than each other
Structural Family Therapy (Minuchin)
"Minuchin - German - Berlin Wall - Structure"
Assumption:
member's
symptoms
are
related to family structure,
which is made up of
subsystems and boundaries
Subsystems
smaller units responsible for carrying out specific tasks (e.g., members to care for the children
Boundaries
vary in
permeability
; exist on a
continuum
Overly
diffuse
(spread out) -->
enmeshed
relationships
Midway
: clear boundaries;
close while allowing for sense of personal identity
Overly
rigid
-->
disengaged
relationships
IDd
4 Rigid Family Triads:
boundary problems that help parents obscure / deny conflicts
Stable Coalition
One parent and a child form inflexible alliance ("team up") against the other parent
Unstable Coalition (Triangulation)
"imagine the fulcrum"
Each parent deamnds the child side with them
Detouring-Attack Coalition
Parents
avoid
conflict between them by
blaming
the child for their (parents') problems
Detouring-Support Coalition
Parents avoid conflict by
Overprotecting
the child
Dysfunctional structure causes family to repeatedly
respond inappropriately to developmental and situational stress
Primary Goal
Alleviate symptoms
and
change structure
by
altering coalitions
AND
creating clear boundaries
Therapy focuses on promoting behavioral change rather than insight with 3 overlaping phases:
1.) Therapist uses
Joining
to establish alliance through 3 techniques
Mimesis:
adopting family's affective, behavioral, and communication style
Tracking:
adopting the content of teh family's communications
Maintenance:
providing members with support
2.)
Evaluation
of structure to diagnose and ID interventions
includes constructing
Family Map
depicting subsytems, boundaries, and other aspects
3.) Uses Reframinig, Unbalancing, Boundary Making, Enactment, and other interventions to achieve goals
Reframing
Relabeling
a problematic behavior to view more constructively
Unbalancing
Alter hierarchical relationships; occurs when therapist aligns with a member whose level of
power needs to be increased
Boundary Making
Alter degree of proximity btwen family members
Enactment
Role-Play a problematic interaction so therapist can obtain info and encourage alternatives
Strategic Family Therapy (Haley)
Assumption
struggles for
power and control
in relationships = core features of family functioning
Symptom =
adaptive strategy
where others had failed
maladaptive fam functioning is often related to
unclear or inappropriate
hierarchies
Primary Goal
Alter interactions
that are maintaining its symptoms
Structure of Therapy
Therapist's role
is active and aimed at changing behavior rather than insight
Initial Session is structured with 4 stages
Social Stage
therapist welcomes fam; observes interactions
Problem Stage
Therapist elicits each member's view of the family problem / causes
Interactional Stage
members discuss their different views; therapist observes how they interact when addressing the problem
Goal-Setting Stage
therapist helps them agree on a definition of problem and concrete goals to target it
Subsequent Sessions
Straightforward Directive
instructions to engage in specific behaviors that'll change out members interactMin
Paradoxical Directives (Techniques)
help membs realize they have control over problematic behavior; use resistance to help them change in the desired way
Prescribing (the symptom)
instructing membs to engage in the problem behavior, often exaggerated way
Restraining
encouraging membs not to change or warning them not to do it so quickly
Ordeals
unpleasant task membs asked to perform whenever they engage in the undesired behavior
Systemic Family Therapy (Milan)
Assumes
Fam as whole protects itself from change through homeostatic rules /
patterns of communication
aka family games
"dirty games:"
games associated with problematic behaviors that are rigid and involve power struggle.
Primary Goal
Alter rules and communication patterns that are maintining problematic behavior
Achieve by
providing info
that challenges games and helps develop comm patterns that
increase ability to adapt
to change
Differences from other family therapies
Uses a
therapeutic team
5-part sessions
Pre-session, session, intersession, intervention, and post-session)
Gaps between sessions can be 4-6 wks
Strategies
Hypothesizing
"continual interactive process of speculating and making assumptions about family situation
initial hypotheses from phone interview then modified as new info is acquired
Neutrality
therapist's interest in family situation and acceptance of each member's perception of the problem
Circular Questioning
asking each member same question to ID differences in perception about events / relationships; uncover patterns (e.g., "When mom is depressed, what does dad do?")
Positive Connotation
type of reframing to help members view symptom as beneficial bc it maintains cohesion / well-being --> change perception of symptom from individual's illness to voluntarily controlled and well-intentioned behavior of entire system
Family Rituals
activities carried out by members btwn sessions; designed to alter problematic "family games" (e.g., when parent are competitive in their control of events / children's behaviors, therapist instructs mother to make all family decisions on odd-numbered days; dad on even)