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Chapter 11 Family Therapy in the TwentyFirst Century

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Title: Chapter 11 Family Therapy in the TwentyFirst Century


1
Chapter 11Family Therapy in the Twenty-First
Century
Family Therapy in the 21st Century
  • Nicole Flores

Nicole Flores
2
Background
  • From the radical experiments of the 1960s family
    therapy has grown into a very established force,
    complete with its own literature, organizations,
    and legions of practitioners.
  • Today, the field has grown up, family therapy is
    no longer separated into different schools and
    its practitioners no longer share a universal
    adherence to the systems theory.

3
Boundaries
  • The boundaries between schools of therapy began
    to blur in the 1990s and no longer were
    therapists classifying themselves solely as a
    Bowenian or structural therapist.
  • One reason
  • -Gained experience, individuals began to borrow
    from other fields and make their own.
  • -The need for individualization, if one family
    didnt fit into one model they weren't the
    right treatment case. Today there is no one size
    fits all
  • Today therapists approach families not as an
    expert that is going to fix them, but as partners
    using all their resources to address the issue.

4
Postmodernism
  • Advances in science at the beginning of the 21st
    century allowed us to see that the truth of
    things could be uncovered through objective
    observation and measurement. The universe was a
    mechanism whose laws awaited discovery and once
    we knew these laws we could control our
    environment. This modernist approach influenced
    family therapists to approach their clients as
    cybernetic systems that are to be decoded and
    reprogrammed.
  •  
  • Walter Anderson Most of the conflicts that tore
    the now-ending modern era were between different
    belief systems Putting truths against each
    other, in FT this was structural truth verses
    psychodynamics Bowen versus Satir.
  •  
  • As the world shrank and we were exposed to
    different cultures, i.e. feminism, and gender,
    we had to reexamine our previous assumptions.
    Everything in our world was questioned,
    deconstructed and then reconstructed.

5
The Feminist Critique
  • Family Therapys rudest awakening.
  • Exposed gender biases in models and treatments.
  • Advocated style of therapy and called systems
    theory, and cybernetics into question.
  • Blaming the victim and rationalizing the status
    quo
  • Dealt with crimes against women such as
    battering, incest, and rape.
  • - Long standing theories have been to imply that
    the women provoked their own abuse.
  • Fighting the stigma that the fathers lack of
    involvement contributed to the mothers over
    involvement and the so called problem child.
  • Solution- bring in father.
  • Reorganize family so that no one is stuck in
    specific positions.

6
Feminist Therapy!
  • Designed to help women and men reexamine the
    gender roles that keep them from realizing their
    full potential.
  • Helping each gender feeling intimate, expressing
    desire, feeling masculine, feminine, and
    powerful.
  • Can be applied to various schools of FT but a
    big debate
  • Feminism as it applies to therapy has less to do
    with clinical methodology than with thinking
    about which belief systems are holding certain
    problems in place.
  • Fem. T is more like a worldview, taking into
    account the pervasive influence of gender and how
    it operates on our lives.
  • Address financial issues between genders as well.
  • Focusing on empowerment!!

7
Social Constructionism and the Narrative
Resolution
  • Constructivism was the lever that pried FT away
    from its claim to objectivity. Instead of
    focusing on family patterns of interaction,
    focusing on exploring the perspectives that
    people have with the interaction.
  • Collaborative therapists were united in their
    opposition to the cybernetic model and its
    mechanistic implications.
  • Their version of postmodernism focused more on
    caring than curing, moving the therapist out of
    the position of expert and more into a
    partnership with the clients.
  • Reflecting team-used for advice in the
    collaborative models therapy- Creates open
    environment where the family feels like a team
    and the team feels more empathy for the family.

8
Social Constructionism and the Narrative
Resolution
  • Therapists do therapy with them not to them
  • Authoritarian attitude vs. a position of not
    knowing leading to genuine conversations. Reflect
    and offer ideas and opinions.
  • Constructivism focused on how individuals create
    their own realities hence, the post-modern
    psychology social constructionism.
  • Emphasized the power of social interaction in
    generating meaning for people. Shifting the focus
    of therapy from action to cognition and took FT
    by storm in the 1990s.
  • Narrative therapy-experiences generates
    expectations and expectations shape experience
    through the creation of organizing stories.

9
Family Therapys Answer to Managed Care
  • Solution-Focused Therapy was a new model that
    rose to popularity in the 1990s.
  • Main goal was to get clients to shift from
    problem talk which is trying to understand
    their problems to a more solution talk which is
    focusing on whats working as quickly as
    possible. During this time agency budgets were
    getting slashed and managed care dictated the
    number of sessions for which practitioners could
    be reimbursed. This created a huge demand for
    this easy-to-apply approach.

10
Family Therapys Answer to Managed Care Cont.
  • Family Violence
  • Systematic views family violence was the outcome
    of cycles of mutual provocation, an escalation of
    the emotionally destructive behavior that
    characterizes many marriages. Family therapy
    brought this into focus and called it what it is
    domestic violence and a very severe health
    concern that needs to be addresses.
  • Multiculturalism
  • FT has shown to embrace all ethnicities, learning
    to respect families of other cultures that have
    their own valid way of doing this.
  • FT is making an effort to become more diverse.
  • Advance over ethnocentrism but pluralism is a
    better term because it implies more balance
    between ethnic identity and connection to the
    larger group.
  • If you dont know ask. 
  •  

11
Family Therapys Answer to Managed Care cont.
  • Race
  • Family therapy for many years ignored people of
    color but FTs like Nancy Boyd-Franklin and Ken
    Hardy brought race out of the shadows and forced
    it into the fields consciousness.
  • Poverty and Social Class
  • Economic disadvantage is related to the ethic of
    self-reliance that people are responsible for
    their own success, if you are poor it must be
    your own fault.
  • Therapists need to educate themselves to the
    social and political realities of being poor in
    the United States.
  • The economy has built in disparities to make it
    difficult to climb out of poverty. Now family
    income is decreasing, mortgages, energy costs,
    tuition are all going up. The therapist should be
    sensitive to the role financial pressures play in
    the lives of their clients.
  •  
  • Spirituality
  • Important to explore a families spiritual beliefs
    without prying or scoffing. Peoples answers to
    those larger questions are intimately related to
    their emotional and physical well-being.
  • Gay and Lesbian Rights
  • After a long period of neglect FT in the late
    1980s began to face this discrimination. However
    despite major advancements in our society gays
    and lesbians still face discrimination and
    violence.
  • The therapist needs to get as much information as
    they can about the identity, relationships and
    issues these individuals face.

12
Tailoring Treatment to Populations and Problems
  • Literature has changed, now no longer tied to any
    one school.
  • Began to focus on how to do FT with a host of
    specific types of problems and family
    constellations.
  • Personalizing the problem to the individual
    and/or family.

13
Single-Parent Families
  • Similar problem as in two-parent families-
  • Overburdened mother enmeshed with kids,
    disengaged from adult relationships.
  • Goal of therapy
  • Strengthen the mothers position in relation to
    her children and help her become more fulfilled
    in her own life.
  • Support the parent and focus on her sources of
    support
  • Not underestimate the impact of poverty on the
    parents depression, self-esteem, independence
    and the decisions they have made about putting up
    with abusive relationship and bad jobs.
  • Recognize the financial hardships and make
    accommodations for the parent s work schedule
    and career choices.
  • Facilitating supportive connections and reducing
    conflict, and develop alliances.

14
Single-Parent Families Cont.
  • Check involvement of the father- is he abusive?
    If not reach out to them and incorporate them
    into the lives of the children.
  • Showing how to interact with their children as
    parents rather than as friends.
  • Live-in partners can be seen as another form of
    support for both the parent and the child. But be
    careful to not over discipline their children
    that is not their role or their job.

15
African American Families
  • Therapists should be ready to expand the
    definition of family to include an extended
    kinship system.
  • This network is one of the keys to coping with
    the pressures of oppression.
  • Therapists job is to find others in the family
    or kin that can help with support but the family
    line can become blurred.
  • Example of Deana and Juanita pg 321.
  • Religion and spirituality provides both real and
    potential resource, gaining strength from the
    church community.
  • One reason for father-absent households- there
    are far fewer men than women in the black
    community, therapist needs to keep the father
    involved with the family
  • Absence of black men are infant mortality rates
    double that of whites, an epidemic of substance
    abuse, death related job injuries and reluctance
    in seeking health care

16
Gay and Lesbian Families
  • Suffer from the same problems as any long term
    couple.
  • Need to learn to balance time tougher.
  • Discuss if they want to have children, if so who
    will be the biological parent.
  • Coping with homophobia in society and in their
    families, decisions about being out
    professionally or only socially.
  • Therapist cant ignore or exaggerate the unique
    nature of same-sex parings.
  • The therapist needs to deal with homophobic
    issues within themselves, one who is anxious
    about working with this couple may not give them
    the appropriate help they need or ask the
    important questions necessary to make appropriate
    assessment.

17
Gay and Lesbian Families Cont.
  • Client self-loathing, negative images of
    homosexuality and same sex relationships. Many
    stigmas are that gay relationships are unstable
    and hard to maintain.
  • Sensitivity to the internalization of traditional
    gender norms.
  • Therapist needs to ask questions about monogamy,
    finances, household duties, jealousy and coming
    out.

18
HomeBased Services
  • A decent of the friendly visitor movement
  • Back in the day, social workers would call on
    families in their homes and may remove children
    out of a harmful situation.
  • Now there has been a huge effort to keep even
    fragile families tougher and prevent placement of
    children.
  • Home-based services target the family as the
    primary recipient of mental health care.
  • Unlike conventional models the home-based
    approach focuses more on expanding the network of
    a familys resources than on repairing family
    dysfunction.
  • A collaborative mind-set and positive
    expectations this is a strength-based approach.
  • Agencies are viewed not as adversaries but as
    potential partners in the treatment process.

19
HomeBased Services Cont.
  • Includes Four elements
  • 1-family support services -help with food
    clothing and shelter.
  • 2-therapeutic intervention- may include
    individuals family, or couple treatment.
  • 3- case management- involves developing links to
    community resources i.e.. Medical care,
    education, welfare, job training etc.
  • 4-crisis intervention- making available 24 hour
    emergency services, wither with the home-based
    agency or by contracting with an outside mental
    health emergency.
  • If there are other agencies with the family then
    learn how to collaborate with them.
  • Dealing with the family in the home may draw the
    therapist into their problems in a more direct
    way than the therapist is used to

20
Medical Family Therapy and Psychoeducation
  • Over the past 15 years this approach has changed.
    Rather than solve problems, the goal of this
    approach is to help families cope with
    disabilities.
  • Psychoeducation therapy emerged from working with
    schizophrenic patients and their families.
  • Medical family therapy developed from healing
    families struggle with chronic illnesses such as
    cancer, diabetes and heart disease.

21
Psychoeducation and schizophrenia
  • A search for the cure for Schizophrenia launched
    the field of family therapy in the 1950s.
  • Today we know that Schizophrenia involves a
    biological origin that is unknown.
  • Family therapy and psychoeducation is considered
    part of the most effective treatment for this
    disorder.
  • The psychoeducation model was born from a
    dissatisfaction with traditional family therapy
    and psychiatric approaches.
  • In the families of schizophrenia there is usually
    criticism, hostility, emotional over involvement
  • This concluded was a high EE (expressed emotion)
    house hold.

22
Psychoeducation and schizophrenia
  • We know now that schizophrenia is a thought
    disorder that renders individuals particularly
    sensitive to the expression of criticism and
    hostility.
  • Theory- intense emotional input makes it
    difficult for patients to cope with the chaotic
    thoughts.
  • It is necessary to reduce EE in helping families
    cope with schizophrenia and lowering EE has been
    shown to reduce relapse rates for major
    depression and bipolar disorder.
  • In the 1970s therapists were experimenting with
    two ways to reduce stress (1970) one was the home
    environment of their parents home.

23
Psychoeducation and schizophrenia
  • Goldstein Model (1978) UCLA- focused on
    anticipating the stresses a family was likely to
    face and then reducing conflict around the
    patient.
  • Others followed suit, (Ian Falloon and Carol
    Anderson). Andersons model looks similar to
    structural family therapy except the families
    structural flaws are considered as the result,
    rather than cause of the presenting problem.

24
Psychoeducation and schizophrenia
  • Psychoeducators try not only to help families
    change their ideas about and interactions with
    patients but also try reverse the damage done by
    insensitive professionals.
  • Seek to establish a collaborative partnership in
    which family members feel supported and empowered
    to deal with the patient.
  • Reeducate professionals to give up the idea that
    the family is responsible for the
    schizophrenia/reinforce strengths/ help family
    develop a sense of mastery.
  • Lower expectations, reduce pressure on patients.

25
Medical Family Therapy
  • Work with families struggling with illness or
    disability, similar to schizophrenics.
  • Help deal or prepare for illness.
  • The system-
  • The sick and their family, the doctors, the
    nurses work in collaboration with all.
  • Goal-
  • Foster communication and support for all.
  • Combat feelings of helplessness and confusion.
  • Families need to explore their options
  • 1990 this part of the field took flight now it is
    called collaborative family health care

26
Relationship Enrichment Programs!
  • This wonderful thing called psychoeducation has
    also been applied to couples and families!
  • Self-help!!
  • Marital enrichment programs!!! YAY!
  • The guru of this field is Bernard Guerney, Jr.
  • He and other facilitators currently teach
    participants to clarify their conflicts, then,
    recognize and express what they are feeling,
    accept each others feelings, negotiate and work
    through problems. Learning to achieve
    satisfaction by becoming emotional partners!

27
Relationship Enrichment Programs!
  • Relationship enhancement programs provide couples
    with three skills
  • The expressive skill-(owning) gaining awareness
    of ones own feelings and taking responsibility
    for them with out projecting onto others.
  • The empathic responding skill-(receptive)
    learning to listen to the other persons feelings
    and motives.
  • The conversive skill-(discussion-negotiation/engag
    ement ) learning to acknowledge the meaning of
    what was heard, partners may switch positions
    between listener and speaker.

28
Discussion Qs!
  • Constructionism-Is moving the therapist out of
    the expert and into the partner role, always
    a good idea? And when can it go wrong?
  • Does the Feminist theory work for every problem?
    And what type of problem would be best to use the
    approach?
  • What common trend do you see through out the
    chapter that is common to other chapters in the
    book?
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