Title: SOCW 674 Social Work and Families Lecture No. Seven
1 SOCW 674 Social Work and Families Lecture No. Seven
Gender and cultural considerations as well as the interface between the family and the broader community in which it is embedded figure prominently in the thinking and clinical approaches of contemporary family therapists.
The trend today is toward eclecticism and integration in family therapy ( Moultrop 1986 Mikesell Lusterman McDaniel 1995 Lebow 1997 ). In this postmodern age that emphasizes that all knowledge is inescapably relative and subjective there is less and less acceptance of the erstwhile belief in the endless possibilities of a single model universally applicable to all client problems and appropriate for all families regardless of cultural background or family type. The prevalence of a wide variety of family configurations (i.e. single families gay couples remarried couples) and culturally diverse groups reinforced the idea that no single theory or set of interventions is likely to fit all equally well.
2 Prochaska and Norcross
Prochaska and Norcross ( 1999) contend that the modal orientation of family therapists today is eclecticism/integration. They note that the psychotherapy integration movement as it is now called is rapidly accelerating for the individual as well as family therapists as psychotherapy has matured and the ideological cold war between the theoretical systems has abated.
Eclecticism is usually pragmatic and case based. Examples of Eclecticism include
-Functional family therapy for adolescent delinquents and substance abusers ( Alexander Waldon Newberry Liddle 1990 )
-Family psycho educational treatment of severe psychiatric disorders ( McFarlane et. Al. 2003 ).
-Multisystemic therapy ( Henggeler Borduin 1990 ) represents an empirically supported family based treatment program based on systems theory and Bronfenbrenners ( 1986 ) social ecology theory which has been directed at treating juvenile offenders and their families.
( 1998 ) Edward Goldners approach to treating violent couples represents still another effort aimed at a specific clinical problem.
Integration more controversial represents a paradigm shift and calls for extensive combining of discrete parts of theories and treatment processes into a higher-level theory that crosses theoretical boundaries and uses
4 Intervention techniques in a unified fashion
Intervention techniques in a unified fashion. While no integrative theory has yet emerged as predominant a number of efforts have appeared they include
(1998) Datillos endeavor to combine systemic and cognitive approaches.
( 1995) Pinsofs attempt to synthesize family individual and biological therapies.
( 1997 ) Wachtels bid to integrate psychoanalysis behavior therapy and the relational world of family therapy..
( (1996) Integrative Couples Therapy ( Jacobsen Christiansen ) represents a successful combination of a humanistic outlook and communication training added to the problem solving techniques of behavioral therapy.
( 2003 ) Lebow contends that the practice models of most family therapists are now integrative and eclectic. No one school or therapeutic approach has a monopoly on effectiveness although efforts to establish evidence-based techniques are under way in some approaches especially emotionally focused couple therapy or cognitive-behavioral family therapy.
5 Psychodynamic Theory
While there may no longer be slavish devotion in practice a therapists theory helps organize what information to seek and how to go about seeking it how to formulate a treatment plan make interventions and understands what transpires.
Psychodynamic theory is concerned with insight motivation unconscious conflict early infant-caregiver attachments. It emphasizes the experiential-humanistic viewpoint emotional growth engagement self-growth self determination. Those that pay attention to a family as a system ( transaction patterns alliances boundaries )-the transgenerational structural strategic and systemic models and those that are cognitive-behavioral in their approach emphasizing learning skills and behavioral change.
( 1997 ) Patterson argues that a clear theoretical position provides the structural underpinnings for assessment and treatment planning to occur.
6 Psychodynamic Theory Con.
He maintains that a therapist must accurately identify the major theoretical orientation from which he or she operates before utilizing congruent intervention methods within it.
(1997) Grunebaum states that while techniques can be borrowed by an eclectic therapist there remains considerable controversy over whether an integrated super theory is ever likely to emerge Grunebaum points out that there are too many inherent incompatibilities in the central theoretical constructs of the major theories for such a conceptual integration to occur.
7 What is the criteria for a solid theory
- Is the theory comprehensive does it deal with family functioning without being trivial or oversimplified Is it generalizable to all families as they behave in all situations ( i.e. only to white middle-class families or only to ways families behave in special psychotherapeutic situations )
- Is the theory parsimonious Does it make as few assumptions as necessary to account for the phenomena under study If two competing theories predict the same behavior is the theory chosen the one with fewer assumptions or constructs
8 What is Solid Theory
- Is the theory verifiable Does it generate predictions about behavior that can be confirmed when the relevant empirical data has been collected
- Is the theory precise Does it define concepts explicitly and relate them to each other and to data (avoiding relying solely on figuarative metaphorical or analogical language)
- Is it empirically valid Do systematic empirical tests of the predictions made by the theory confirm the theory
- Is the theory stimulating Does it provoke response and further investigation to enhance the theory and even to demonstrate its inadequacies
Psychoanalysis both as theory and as a form of practice deserves recognition for playing the central role in establishing and defining the nature of psychotherapy ( Sander1998). It initially focused on treating neurotic individuals by examining and reconstructing childhood conflicts generated by the colliding forces of inner drives and external experiences psychoanalysis became the dominant ideology in American psychiatry after World War II. Erik Erikson and Erich Fromm were psychoanalytic in their orientation came to America to escape Nazi persecution.
America became receptive to the ideas of Sigmund Freud and psychoanalysis became accepted by medical specialists academicians and clinicians. Indeed many of family therapys pioneers AckermanBowenLidzJackson Minuchin Wynne Boszormenyi-Nagy ( all men ) were psychoanalytically trained.
10 Freuds Impact on Family Therapy
Freud introduced the idea of defense mechanisms (such as displacement) and the unconscious ego that a person calls upon as protection against being overwhelmed by anxiety. He recognized that the family provided the early environment-or context-in which neurotic fears or anxieties developed. He did not go further to identify how current and ongoing family relationships helped maintain the maladaptive or problematic behavior. His therapeutic efforts concentrated on how the patient remembered it and not on how his family functioned.
Freud opposed working with more than one family member at a time that his negative assessment virtually became unquestioned among psychoanalysts which for many years accepted the prohibition against analyzing members of the same family ( Broderick And Schrader 199!.
11 (1975) Bowen
(1975) Bowen noted that one psychoanalytic principle that may have retarded the earliest growth of the family therapy movement was the isolation of the therapist-patient relationship and the related concern that contact with the patients relatives would contaminate the therapist. Bowen reported that some hospitals had one therapist deal with the patients intrapsychic processes while another handled practical matters and administrative procedures and a third team member a social worker talked to relatives.. According to Bowens early experiences failure to respect these boundaries was considered inept psychotherapy.
12 Adler and Sullivan
Alfred Adler was an early associate of Freuds in Vienna. He helped found the Child Guidance movement in the 1900s. He was a physician initially trained in ophthalmology later specializing in neurology and psychiatry treating childhood disorders. . Adler invited by Freud joined the Vienna Psychoanalytic Society in 1902. Adler eventually developed divergent views from psychoanalytic theory emphasizing the importance of social and family factors as opposed to Freuds drive theory ( Scharf 2000 ).
Adler particularly challenged Freuds lack of attention to social elements in personality formation. He offered in its place a theory rooted in social relationships. All behavior is purposeful and interactive and the basic social system is the family ( Carlson Sperry And Lewis 1997). Adler broke with Freuds biological driven theory- substituting social purposeful and developmental determinants. Adler formed the Society For Individual Psychology in 1914. they emphasized the importance of the total individual in the therapeutic undertaking.
Adler insisted on an individuals conscious personal and social goals as well as subsequent goal-directed behavior could be understood only by comprehending the environment or the social context. especially the family in which the behavior originated and was displayed. Adlerian concepts such as sibling rivalry family constellation and style of life points to Adlers awareness of the key role of family experiences in influencing adult behavior. Hew had a holistic view of the human person as unpartitionable which has applicability to the systems outlook of many family therapists. Adlers direct family therapy connection can be seen in psycho educational efforts such as marriage enrichment programs parent education programs aimed at facilitating adult understanding and cooperation ( Dinkmeyer McKay Dinkmeyer McKay 1997).
14 Harry Stack Sullivan
Harry Stack Sullivan an American Psychiatrist was psychoanalytically trained. He began his career in the 1920s and he stressed the role of interpersonal relationships with the family and with outsiders in personality development. Sullivan ( 1953) argued that people are essentially products of their social interactions to understand how people function he urged the study of their relatively enduring patterns of recurrent interpersonal situations.
He stressed the importance of peer relationships in personal and social development believing that the seeds for later disturbance occurred in early dealings with others. He emphasized the importance of the mother-child dyad arguing that formative experiences lead to viewing parts of one self as the good me the bad me and the not me. He worked mostly with Schizophrenics at Sheppard Pratt Hospital in Baltimore MD.. He noted that the disturbance frequently manifested itself during adolescence leading him to speculate about the possibly critical effects of the patients ongoing family life in producing the confusion that might lead ultimately
Lead to schizophrenia ( Perry 1982 ). Sullivan ( 1940) described his way of engaging patients as acting as a participant observer anticipating by several decades the current second order cybernetic idea of the therapist being a part of the therapeutic system.
16 Nathan Ackerman
Nathan Ackerman- a psychoanalyst and child psychiatrist is generally credited with deliberately adapting psychoanalytic formulations to the study of the family. The first paper published on family therapy was in the Bulletin of the Kansas Mental Hygiene Society. Ackerman (1937) emphasized the influence of the family as a dynamic psychosocial unit in treating one of its emotionally disturbed members. The constant interaction between the biologically driven inner conflicted person (a psychoanalytic concept) the family and the social environment ( a person-systems concept ) was to preoccupy for the next three decades as he struggled to apply an intrapsychic vocabulary to family diagnosis and treatment.
17 The Psychodynamic Outlook
-Psychoanalytic drive theory first introduced by Sigmund Freud
-Object relations theory- revision of earlier psychoanalytic formulations
With an emphasis on the search for satisfying human relationships.
The self psychology theory of Heinz Kohut with its emphasis on
The role of narcissism ( love of self ) as an organizing determinant of
Personality development and a necessary precursor of loving others.
18 The psychodynamic view
The psychodynamic view of individual behavior is derived from Freuds psychoanalytic model this focuses on the interplay of opposing innate forces ( or drives ) within a person as the basis for understanding that persons motivation conflicts and symptomatology. Drives motivate behavior by way of bodily demands that take the form of unconscious wishes and impulses seeking satisfaction. Freud stated that each drive has four components
an aim( the release of sexual or aggressive tension )
- a source ( in the case of hunger for example the bodily need for nourishment )
An impetus ( the pressure or urgency of the drive )
An object ( person or thing or condition that will satisfy the drive
i.e. food sexual intercourse etc. ). An object choice first stated by Freud can be a significant person or anything that is a target of another persons feelings or drives ( St. Clair 2000 ). It is important to note that it is not the real object per se nor how that object or person behaves in real life that is at issue but rather the fantasies about the object that the perceiver experiences. So falling in love with another person according to Freud primarily involves investing energy in ones inner thoughts or mental representations of that person.
19 By the mid 1980s
By the mid 1980s a more integrated view was being advocated by family therapists who urged that systems thinkers not neglect the individual family members personal conflicts and motivation ( Slipp 1984 Nichols1987 ). Presently the interlocking systems of the individual the family and the community are at the forefront many Freudian ideas about the needs and conflicts of individual members are being revisited alongside family relationship patterns and the impact of community life.
20 Bentovim and Kinston ( 1991 ) and Slipp ( 1991)
Bentovim and Kinston ( 1991 ) and Slipp ( 1991) have developed a model that merges psychodynamic and family systems concepts. These British family therapists present a model called focal family therapy. In the United Kingdom family therapy developed out of the child guidance movement- this approach is developmentally oriented and looks for family disturbances especially traumatic events to family members that have led to intrapsychic and interpersonal disturbance within the family. I formulating a focal hypothesis about a familys conflict these therapists consider the familys response to the symptom in the identified patient the function of symptom in family functioning what keeps the family from facing their conflicts directly and any link to past trauma.
21 Samuel Slipp ( 1991)
Samuel Slipp ( 1991) psychiatrist attends to any significant childhhod development of the participants while addressing ongoing family interaction using the framework of object relations theory. Both individual and family diagnoses are part of Slipps treatment plan in his effort to integrate psychoanalytic and systems concepts and therapeutic methods.
22 Nichols ( 1987 )
Nichols ( 1987 ) Interactional psychodynamics remaining attentive to the circular nature of personal and family dynamics.
Nichols argues for the restoration of individual dynamics into psychodynamic family therapy no matter how much attention is focused on the entire family system individual family members will remain separate persons with unique experiences private hopes ambitions outlooks expectations and potentials.
Psychoanalytically oriented therapists practicing object relations therapy have become more focused instead of remaining a blank screen on which patients project their fantasies these therapists try to participate in a holding environment ( a safe nurturing setting ) caring for family members while remaining aware of transference processes. In the shared holding process the family is encouraged to feel free to interact safely in front of a trusted therapist.
23 Object Relations Theory
Object Relations Theory (1950s ) first developed in Great Britain in the 1950s. It emphasizes that the fundamental need in people is for attachments and relationships. (Objects refer to the persons or things to which a person relates or otherwise gains gratification). In object relations family therapy ( Scharff Scharff 1987 ) the interacting forces both within and between individuals are explored in the process of treatment. In particular efforts are directed at examining thwarted relationships experiences early in life particularly mother-child interactions that have become internalized and that shape a childs inner world and later adult relationships and experiences (St. Clair 2000 ).
24 Heinz Kohut
Heinz Kohut ( 19711977) American psychiatrist born in Vienna was responsible for a major development in contemporary psychoanalysis. Kohut published a series of books that challenged some tenets of classical psychoanalysis such as drive theory. Kohut developed self psychology theory. Kohut analyzed patients with narcissistic personality disorder whom Freud thought to be unanalyzable because they were not able to invest or engage in a relationship with the analyst. Kohut argued that narcissistic personality difficulties ( as well as others ) result from a failure in childhood to develop confident feelings about oneself as a result of poor experiences with inadequate or unavailable parents As a result narcissists self-centered and with a powerful need for attention and admiration are likely to see themselves as the center of all relationships in which they engage.
25 St Clair ( 2000 ) Kohuts work
St Clair ( 2000 ) Kohuts work helps explain why narcissistic persons do not necessarily withdraw interest from outside objects but rather are unable to rely on their own inner resources instead creating intense attachments with others.
26 Nathan Ackerman
Nathan Ackerman then head of the Child Guidance Clinic at the Menniger Clinic in TopekaKS started to experiment and see families together. In order to obtain a complete picture of family functioning as he could especially among families suffering economic hardships during the Great Depression Ackerman had members of his staff make home visits with client families ( Guerin 1976 ).
( 1960 ) Nathan Ackerman opened The Family Institute in New York. (
27 Grandfather Of Family Therapy
1970) Ackerman who is regarded as the grandfather of family therapy. He saw the family as a system of interacting personalities each individual is an important subsystem within the family just as the family is a subsystem within the community. He grasped early a full understanding of family functioning and acknowledged inputs from several sources
-the unique personality of each member
-the dynamics of family role adaptations
- The familys commitment to a set of human values
- the behavior of the family as a social unit
Ackerman argued on the individual level the process of symptom formation came to be understood in terms of intrapsychic conflict.
an unconscious defense against anxiety aroused by the conflict and the resulting development of a neurotic symptom ( psychoanalytic explanation ). At the family level the symptom is viewed as part of a reoccurring predictable interaction pattern intended to assure equilibrium for the individual but actually impairing family homeostatis by producing distortions in family role relationships. In family terms an individual symptoms becomes a unit of interpersonal behavior reflected within a context of shared family conflict anxiety and defenses.
29 A failure of complementarity
A failure of complementarity- characterizes the roles played by various family members with respect to each other. Change and growth within the system becomes constricted. Roles become rigid narrowly defined stereotyped shifting rapidly causing confusion. For familys behavior to be stable flexibility and adaptability of roles are essential roles within the family which change over time must allow for nurturing children to gain an appropriate degree of autonomy.
Conflict occurs within an individual family member between members of the nuclear family between generations and extended family or between family and the surrounding community. Ackerman states that conflict at any level reverberates throughout the family system. A breakdown of role complementarity may lead to interpersonal conflict within the family and ultimately to intrapsychic conflict in one or more family members the individuals conflict deepens if the internalized family conflicts are persistent and pathogenic in form. Ackerman wanted to actively interrupt this sequence by extrapolating intrapsychic conflict to the broader area of family interaction.
Ackerman argues that the process begins when one family member often noted to be different from the others- becomes the family scapegoat. As that individual is singled out and punished for causing family disunity various realignments of roles follow within the family. One member becomes persecutor while another takes the role of healer or rescuer of the victim of such prejudicial scapegoating
Ackerman observed that family alliances and interpersonal conflict begin with a failure of complementarity within the marital dyad the family is precluded from functioning as a cooperative supportive integrated whole. In such cases as these Ackermans therapeutic mission was to shift familys concern from the scapegoated person to the basic disorder of the marital relationship.
Ackerman was concerned about the impact of family environment on the development of childhood disorders. He was the first to note the constant interchange of unconscious processes taking place between family members as they are bound together in a particular interpersonal pattern. Any single members behavior can be a symptomatic reflection of confusion and distortion occurring in the entire family.
34 Interlocking pathology
Interlocking pathology- as one family member gets better another family member gets worse. A patient improved in their treatment and as a result their marriage failed.
Ackerman was always interested in how people define their roles ( What does it mean for you to be a father ) and what they expect from other family members ( How would you like you daughter to react to the situation). When family members delineate their roles more clearly family interactions proceed more smoothly.
Members can rework alignments engage in new family transactions and cultivate new levels of complementarity in their role relationships.
Ackerman sees his role as family therapist as being the catalyst moving into the living space of the family stirs up interaction helps the family to have a meaningful emotional exchange and at the same time nurtures and encourages the members to understand themselves better through the contact with the therapist. As catalyst the therapist is also activator challenger confronter supporter interpreter integrator. Ackerman discerned patterns of role complementarity and tickled the defenses ( gently provoking participants to openly and honestly express what they feel ) he caught members off guard and exposed their self-justifying rationalizations. Ackerman ( 1982) The Strength Of Family Therapy a collection of his papers. He was the first one to demonstrate his work with families before a professional audience breaking the psychoanalytic code of secrecy about what really went on in therapeutic sessions.
38 Object Relations Theory
The structural conflict between the id impulses and those parts of the personality that Freud labeled the ego and the superego- is the soil from which psychopathology grows ( Slipp 1988 ). Acting out an impulse unconsciously becomes associated with the danger of reprisal- physical punishment loss of love from parents or other key parent figures in a childs life.. The combination attention to individual drives ( motives ) the development of a sense of self ( wishes fears internal conflicts ) and unconscious relationship seeking that object relations theory addresses.
39 Classic psychoanalysis
Classic psychoanalysis is considered to be a drive theory.-inborn sexual and aggressive impulses emanate from the Id. Having created an excitation these impulses lead to unconscious fantasies as the individual endeavors to achieve gratification through the discharge of these drives. However the drives behavioral expression may lead to perceived danger or a fear of punishment. The resulting structural conflict- between the id impulses and those parts of the personality Fred labeled Ego and Superego- is the soil from which psychopathology grows ( Slipp 1988 ). Acting out an impulse unconsciously becomes associated with the danger of reprisal-
40 Physical punishment loss of love
Physical punishment loss of love from parents or other key parent figures in the childs life.
It is precisely the combined attention to individual drives ( motives ) the development of a sense of self ( wishes fears internal conflicts ) and unconscious relationship seeking that object relations theory addresses and that helps explain the revived interest in psychoanalytic formulations by some family therapists.
41 Object Relations theory
Object Relations theory views the infants experiences to the mother as the primary determinant of adult personality formation. According to the theory the infants need for attachment to the mother is the foundation for the development of the self- the unique psychic organization that creates a persons sense of identity ( Scharff Scharff 1992 ).
Bowlby ( 1969 ) considers issues of attachment and loss to be central to functioning in humans and all higher mammals he argues that how people resolve these issues determines personality development and possible psychpathology.
Attachment refers to the early emotional bond that develops ( or fails to develop adequately ) between infants and their caregivers. According to John Bowlby ( 1969) infants develop a secure attachment when certain core needs in the developmental process are met. When secure the infant who becomes frightened or feels threatened a normal occurrence will reach out to the caregiver ( usually but not necessarily the mother ) for responsiveness comfort and protection confident that it will be forthcoming.
43 Mary Ainsworth ( 1978 )
Mary Ainsworth ( 1978 ) has described the complex interactive process by which mother and child communicate. According to Ainsworth most infants form secure attachments upset if the mother leaves but easily calmed when she returns. Others display an anxious-ambivalent attachment loudly protesting her departure and not particularly comforted by her return. And a third group demonstrate avoidant attachment seeking little connection to the mother not distressed when she leaves and often rejecting others of comfort.
44 Hazan And Shaver ( 1987
Hazan And Shaver ( 1987 ) state that secure adults are able to trust others and not fear abandonment and avoidant adults fear rejection and abandonment and avoidant adults have difficulty establishing a close and confident connection to others.
45 Scharff Scharff ( 2003 )
Scharff Scharff ( 2003 ) attachment styles in insecure adults that they may be insecure in various ways- preoccupied with and dependent on close relationships dismissive of the need for closeness and compulsively self-reliant or down right fearful of rejection.
46 Melanie Klein ( 1926)
Melanie Klein ( 1926) British Psycho analyst who emigrated from Vienna in 1926 proved much of the foundation for object relations theory. Kleins contributions focused attention on the infants innate or instinctual make-up beginning at birth involves a world of fantasy he or she first experiences objects such as the mother through fantasies. It is the basis of such prior fantasies that the infant filters real life experiences. Klein was able to delve into the fantasies of young clients and to expand previous psychoanalytic formulations to cover the earliest phases of life.
47 British Middle School of Object Relations Theory
British Middle School of Object Relations Theory ( Michael Balint Ronald Fairbairn Harry Guntrip Donald Winnicott).
48 W.R. D. Fairbairn ( 1952 )
W.R. D. Fairbairn ( 1952 ) a psychiatrist in Edinburgh Scotland maintained that because the infant experiences different sets of encounters with a mothersometimes nurturing sometimes frustrating- and cannot control the circumstances or leave the relationship he or she creates a fantasy world to help reconcile the discrepant experiences. In the process called Splitting the child within the first year of life internalizes an image of the mother into a good object ( the satisfying and loving mother ) and a bad object ( the inaccessible and frustrating mother ) forming distinct internal
Relationships with the separate objects. The former becomes an idealized object and allows the child to feel loved the latter a rejecting object that leads to anger a feeling of being unloved and a longing to regain that love.
Fairbairn also talked about Introjects ( imprints of parents or other significant figures ) such as pleasing memories bad object introjects cause intrapsychic distress.
49 British Psychologist Henry Dicks ( 1967 )
British Psychologist Henry Dicks ( 1967 ) Family Psychiatric Unit of the Tavistock Clinic in LondonEngland talked about the defense mechanism of projective identification an interactive mental process in which marital partners unconsciously defend against anxiety by projecting or externalizing certain split-off or unwanted parts of themselves onto their partners.
Object relations theorists believe that we relate to people in the present partly on the basis of expectations formed by early experiences ( Nichols 1987 ).
50 Object Relations And Family Of Origin Therapy ( James Framo )
James Framo ( 1981) stressed the relationship between the intrapsychic and the interpersonal offering an amalgram of psychodynamic and systems concepts. Framo is particularly celebrated for his advocacy of couples groups. Framo believed that psychoanalytic theory did not pay sufficient attention to the social context of a persons life particularly the early crucial role played by family relationships in shaping individual behavior. Framo refused to polarize the intrapsychic and the interactional maintaining that both are essential to understanding the dynamic aspects of family life.. Framo worked at the Eastern Pennsylvania Psychiatric Institue ( EPPI ) and had an academic career at Temple university. He also worked in San Diego as both teacher and practitioner until his death in 2001.
51 At EPPI Framo
At EPPI Framo began to view family dysfunction as rooted in the extended family system. He developed a set of intervention techniques that helped couples in marital therapy deal with unresolved issues each partner brings to the marriage from his or her family of origin. Consistent with the view of Object Relation theorists Framo believed that the insoluble intrapsychic conflicts derived from ones family of origin continue to be acted out or replicated with current intimates such as a spouse or children.
52 Framo (1976)
Framo (1976) theorized that a young child who interprets parental behavior as rejection desertion or persecution is in a dilemma this child cannot give up the sought-after object (the parents) nor can he or she change that object. Typically the ensuing frustration is dealt with by internalizing aspects of the loved-hated parents in order to control the objects in the childs inner world.
53 Framo (1992)
Framo (1992) insisted that people usually do not select the partner they want they get the one they need. Therapeutically Framo began by treating the entire family especially when the presenting problem involved the children.. However symptomatic behavior in a child may simply be a means of deflecting attention from a more basic marital conflict. In such cases once the childs role as an identified patient is made clear and the child is detriangulated from the parents Framo typically dismissed the children and proceeded to work with the marital dyad.
54 Framos unique contribution
Framos unique contribution to family therapy was in the process of guiding a couple through several treatment stages conjoint therapy couples group therapy and finally family-of-origin (intergenerational)
Conferences. The couples group in which many couples participate soon after beginning treatment allowed Framo to use many of the positive aspects of group therapy especially the therapeutic feedback from other couples to assist his therapeutic efforts.
55 In a daring therapeutic maneuver
In a daring therapeutic maneuver Framo (1992) involved each individual (without the partner present) in sessions with his or her family of origin (parents brothers and sisters). Here instead of the customary working out of past or current problems with these family members via a relationship with the therapist Framos family-of-origin approach proved a direct opportunity for clearing up past misunderstandings or sources of chronic dissatisfaction.
56 Object Relations Family Therapy ( Scharff Scharff )
Object Relations Family Therapy ( Scharff Scharff )
An object relations approach more faithful to orthodox psychoanalysis comes from the collaboration of David Scharff and Jill Savege Scharff husband and wife psychiatrists affiliated for many years with the Washington School Of Psychiatry and now directors of their own institute- The International Institute of Object Relations Therapy in Washington D.C.
57 In the Scharffs therapeutic approach
In the Scharffs therapeutic approach unconscious themes expressed in dreams and fantasies are evoked and investigated family histories are explored as they relate to current relationships interpretations are made to the family insight is sought and transference and counter transference feelings are explored in an effort to arrive at greater understanding and growth. Consistent with drive theory the Scharffs attempt to aid the couple in overcoming resistance in order to become aware of repressed impulses.
58 According to the Scharffs interpretation
According to the Scharffs interpretation by the therapist in order to provide insight is essential.. The Scharffs make use of transference which they view broadly as occurring between each family member and the therapist and particularly between the family as a group and the therapist.
59 Each partner
Each partner is encouraged to examine his or her early nurturing or caring- what the Scharffs call holding experiences and how the images retained from those experiences affect the couples current marital relationship and their view of the therapist. The familys shared object relations are assessed as are the familys stage of psychosexual development and its use of various mechanisms of defense against anxiety.
60 Donald Winnicott ( 1965)
Donald Winnicott ( 1965) British pediatrician a member of the British Middle School of Object Relation theorists describes the needs of the infant to avoid feeling abandoned or annihilated.
Unlike Freud who was aware of parental figures but stressed the infants inner world and instinctual drives Wiinicott underscored the significance of the infants environmental needs especially for parents to provide sufficient care and attention for the infant to experience a good start in life.
61 Kohut And Self Psychology
( 1971 1977 ) Heinz Kohut retreated from Freuds drive theory and was more receptive to the idea of intrapsychic forces (gratifying the needs of the Self ) and interpersonal forces operate in a reciprocal fashion. These ideas are now at the forefront of todays practice for many clinicians wit psychoanalytic or object relations views.
Kohut a physician retired in Vienna spent most of his career at the Chicago Institute of Psychoanalysis. He formulate his influential ideas regarding self-psychology emphasizing the relationship between the self ( the persons personality core or center of initiatives ) and outside objects as the defining principle of human lives.
Kohut contends that initially the infant does not view its parents as separate persons or objects rather the parents are seen narcissistically as self-objects extensions of the infant represented by attention and praise from its environment. That is the infant makes no distinction between itself and its mothers praise (although it may not view her as a real object yet).
Kohut maintains that the infant does not yet have a self even if the parents think otherwise. That core self begins to emerge from interactions with and responses from self-objects. Ideally according to Kohut young children start to develop a core cohesive self when they experience two qualities from their attentive parents-empathy (validating how they feel ) and idealization of parents ( being proud to have good parents and to be part of them ). As a result of internalizing parental appreciation the child forms an autonomous self characterized by self-acceptance and self-esteem. Such fortunate children are said by Kohut to have needs mirrored by their parents and the idealization met by satisfying interaction with parents who themselves feel self-esteem. Less fortunate children- those whose parents fail to demonstrate sufficient appreciation or themselves have little self-esteem- continue to crave admiring attention throughout life.
Narcissism then is ever present especially among infants and young children and represents a stage of development. All adults continue to have
Narcissistic needs they wish to fulfill and continue to need the mirroring of the self by self-objects through out life ( St. Clair 2000 ). As Kohut ( 1971 ) seeking a connection with someone who is unresponsive or indifferent often makes us feel unloved with lowered self-esteem and in Kohuts view filled with narcissistic rage.
66 Based upon his work with patients
Based upon his work with patients Kohut (1971) contended that the infants core self is likely to contain a self-centered grandiose-exhibitionist ic part especially if the parent offers unconditional admiration. Because the child will inevitably be frustrated at not receiving everything wished for the conflict at this early stage is often between doing what the child wants and believes he or she deserves ( the self-assertive grandiose self ) and what the child believes the idealized parent wants him or her to do ( the idealized self-object ) says Kohut ( 1977 ). Tantrums at being frustrated thus represent narcissistic rages- the removal of the mirroring self-object. Kohut considers such tantrums as a normal sequence in the development and precursor of object love. Such mature love is likely to involve mutual mirroring and idealization.
67 Working with patients with narcissistic personality disorder
Working with patients with narcissistic personality disorder Kohut contends that they are experiencing a defect in the structure of the self not having successfully completed the integration of the grandiose and idealized object into a reality-oriented self. He found that those who grew up feeling insufficiently admired or attended to will seek such acceptance in exaggerated narcissistic cravings experiencing others as self-objects. To the narcissistic adult then a self-object is a person undifferentiated from oneself who serves the needs of the self.
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