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Foundation Concepts in Family Therapy

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challenge to Early Family therapy: ... and relationships Reframing is a constructionistic technique: co-creating reality Moves therapy into the cognitive realm, ... – PowerPoint PPT presentation

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Title: Foundation Concepts in Family Therapy


1
Foundation Concepts in Family Therapy
  • Some of the Core concepts covered in Chapters 1-4
  • EPSY 6393 with Dr. Sparrow

2
Myths to be shattered
  • Health could be achieved only by leaving home
    the hero myth
  • Freud Effects of family were real, but they were
    intrapsychic, and in the past
  • Rogers Self actualization could only be pursued
    in isolation from the familys oppressive
    influence

3
Family therapys premises
  • That the forces of change are located external to
    us, in the family system
  • That change in any member affects the whole
    family systems theory

4
Which approach is best?
  • Individual therapy when the social relationships
    are stable, and the person is in distress
  • Family therapy when the social relationships are
    unstable, and the person is in distress

5
Big concept The Family is a System
  • The family system is more than a collection of
    individuals
  • It is an organic whole with its own identity and
    dynamics
  • Members function in the system differently than
    they do in isolation

6
Circular Causality
  • Based on the idea that we are in a constant
    feedback loop with the persons in our lives. Also
    referred to as cybernetic loops, or
    synchronous feedback.
  • Linear causal explanations try to find who is at
    fault, or to blame.
  • Circular causal explanations try to understand
    what each person is doing that sustains the
    problem, and what they can do differently to
    change the situation.

7
Family Therapy is simpler than you Think!
A Small Number of systems dynamics accounts for
most family distress, so relax, you can do it!
Dr. Sparrow says
8
Group Theory The Basis for Family Therapy
  • Group theory provided a foundation for
    understanding the family
  • Lewin
  • group is more than sum of parts
  • interaction could be curative
  • a focus on the here and now ahistorical
  • Groups are inherently tense as members vie for
    freedom and services
  • Process dimension became more important than
    content how, not what

9
How Groups differ from Families
  • Group members come to therapy to find a sanctuary
    in which to discuss problems vs. families bring
    their problems into the office
  • Group members can be assured that what they say
    in therapy wont follow them home vs. families
    have to live with the consequences of their
    disclosures
  • Groups are comprised of equals without a past vs.
    families are comprised of unequal members who
    have a past and future together

10
Early Misconceptions
  • The mother-child bond was the source of all
    problems, e.g. schizophrenegenic mothers.
  • Parents are always to blame, and children have to
    be protected from them.

11
The First Family Therapists The Palo Alto Group
  • Batesons work with communication in
    schizophrenic families led to some of the first
    important contributions the the field.
  • rules
  • Metacommunicaton (report and demand)
  • double binds
  • feedback, or cybernetics
  • homeostasis (Jackson)

12
Negative and Positive Feedback
  • When a familys rules are challenged, the family
    usually treats this challenge as negative
    feedback, that is a reason to reassert its rules
  • Positive feedback is information that a family
    perceives as a call to change its rules.

13
Families Break down under Stress
  • Normal families need help when they cant adjust
    to stress
  • Family rigidity, or a refusal to alter rules,
    keeps a family from adjusting to change
  • Life changes bring about
  • developmental stressors
  • environmental stressors

14
Big Concept Families resist change
  • Homeostasis means that families resist change
  • Direct attempts to foster change will evoke
    resistance
  • Insight is unnecessary, and can even get in the
    way.
  • Therapist must take an indirect approach in order
    to succeed

15
Relationships are Symmetrical or Complementary
  • Symmetrical relationships have a lot of
    similarity and equality -- common ground,
    comfortable
  • Complementary relationships are based on
    differences, opposite attraction -- not much
    common group, very dynamic
  • The pursuer-distancer dynamic grows out of
    complementary roles

16
Triangles are a basic structure in dysfunctional
families
  • Triangles form when a person seeks out a
    substitute for relating to a person with whom he
    has difficulties
  • Cross-generational coalitions are a triangle
    between two generations that is one parent
    joining with a child against the other parent.

17
Palo Alto Brief Therapy School
  • Based on the idea that families resist change
  • Assumed that a direct approach would only provoke
    resistance
  • downplayed importance of insight in fact,
    considered insight to be an obstacle at times

18
Milton Ericksons influence on Jay Haley
  • Erickson mastered techniques for circumventing
    resistance in hypnotic subjects.
  • Symptom prediction, symptom prescription
    (paradoxical or strategic)
  • Indirect methods
  • Reframing

19
Bowens Systems Family Therapy
  • differentiation of self is central concept
  • triangle is smallest stable unit of relationship.
  • cross generational transmission of patterns
    focused on the family of origin, not the nuclear
    family
  • genograms as a way of assessing generational
    patterns

20
Whitaker and Satir Experiential Family therapy
  • Existential-humanistic, person centered
  • Believed that family members needed to unlease
    their true feelings, and become more honest with
    each other.
  • Believed that humans were essentially good, and
    just needed to be helped in expressing the truth
    of who they are.

21
Minuchins Structural Family Therapy
  • boundaries disengagement and enmeshment
  • hierarchies
  • joining
  • enactment
  • restructuring

22
Origin of Family problems
  • As already stated, families break down when
    unable to adjust their rules to accommodate new
    developments
  • Family therapists are interested in what was
    happening when the problem arose
  • But more interested in what the family is doing
    to perpetuate the problem
  • The familys solution is often the problem --
    the reassertion of old rules

23
Process is Everything
  • As mentioned earlier, a therapist must focus on
    what is going on between members, not the
    specific problem
  • If a therapist tries to solve the problem as its
    defined, rather than looking at the way the
    family sustains the problem through their
    interaction, there will be no progress.

24
What you do depends on Your style and theory
  • Some therapists will openly point out the
    problems in relating, in order to bring about
    insight.
  • Some therapists will actively manipulate the
    family (move them around, get them to interact,
    etc.) to bring about change in the session,
    without worrying about insight.
  • Some will do both.

25
Major interventions
  • Joining -- Minuchin
  • Process Questions -- Bowen
  • Genograms -- Bowen
  • I position (to stop blaming) -- Bowen
  • Reframing -- Haley, Minuchin
  • Paradoxical interventions and therapeutic double
    binds -- Haley
  • Enactment and restructuring-- Minuchin

26
Session Objectives First session
  • Joining Making contact with each person. Balance
    warmth and professionalism to prevent induction.
  • Assess problem from each persons perspective
  • Explore specific problems and attempted
    solutions Use process questions to explore.
  • Develop hypotheses about the interactions that
    are sustaining the problem.

27
Early Phase Objectives
  • Keep it simple. Focus on primary problems and the
    dynamics perpetuating them.
  • Formulate hypotheses around structure and
    dynamics, not so much the personal or
    intrapersonal aspects.
  • Bring the problem into the office. Allow
    interaction and support enactments.
  • Reframe, challenge, and restructure the enacted
    dynamics around new boundaries
  • Assign homework that continues the new
    relationship dynamics

28
Mid-Phase Objectives
  • Foster responsibility challenge the blame game
    with process statements/questions, unbalancing,
    and reframing
  • Keep your efforts related to primary complaint,
    but your interventions focused on interactive
    process.
  • Use intensity to challenge members to demonstrate
    their competencies
  • Dont splinter the family into subgroup work
    without keeping the big picture in mind.

29
Termination
  • A time for the family to evaluate its progress,
    and to consolidate what theyve learned.
  • Do they get it?
  • Are the benefits being seen elsewhere?
    (generalization of therapeutic gains)
  • Are they satisfied?
  • Can they do it on their own? Are relapses merely
    part of the growth process, or are there problems
    that you still need to address?
  • Immunization strategies preparation for relapse

30
Exceptions and Ethics Issues Pertaining to
Marital and Family Work
  • Child abuse
  • Domestic violence
  • Confidentiality, triangulation, attraction

31
Chapter Four Deepening Our Knowledge of Systems
  • Cybernetics revisted Sequences of family
    dynamics negative and positive feedback
  • Closed systems and open systems therapist role
    living systems are open, and exhibit
  • equifinality
  • morphogenesis -- tendency to seek change

32
Chapter Four Deepening Our Knowledge of Systems
  • Systems dynamics explains several relationship
    problems that tend to get worse without outside
    intervention
  • Controller/rebel
  • Approacher/distancer
  • Overfunctioning/underfunctioning

33
Chapter Four Deepening Our Knowledge of Systems
  • Systems dynamics are revealed through spontaneous
    sequences of behaviors. These sequences tend to
    erupt early in the family therapy sessions. By
    allowing them to occur, you can see the problem
    in action, and (depending on your approach) can
    intervene to get the family to correct it.

34
challenge to Early Family therapy Social
constructionism
  • Relates to the age-old notion that knowledge of
    the world is filtered through beliefs,
    experience, and language, and relationships
  • Reframing is a constructionistic technique
    co-creating reality
  • Moves therapy into the cognitive realm, away from
    focus on behavior.
  • Minimizes the importance of the therapist as an
    expert

35
Constructionism challenges Prevailing Truths
  • Cultural and gender assumptions vary over time,
    so roles are changeable.
  • Social truths become enshrined within
    prevailing approaches to therapy
  • Deconstruction of the socially constructed
    narrative is essential.
  • Collaboration is essential within a social
    constructionist approach

36
Attachment Theory
  • Is a way that family therapy has reintroduced
    psychodynamic concepts into relational events.
  • Assumes that the basic human impulse is to form
    secure bonds, or to seek closeness in the face of
    stress.
  • When the formation of secure bonds are disrupted,
    a child reacts in two different ways.
  • Resistance/clinging
  • avoidance

37
Summary
  • Context is more important than content, so it is
    important to meet with the family to establish
    the context of a persons distress.
  • People are complementary, and will compensate for
    their partners style by going the other
    direction. This creates a number of workable
    problems.
  • Families and couples are constantll engaged in
    circular exchanges. Solutions have to take this
    into account.

38
Summary
  • Triangles account for much of a couples or a
    familys dysfuntion. Direct communication or
    detriangling is the solution.
  • Process is always more important than content.
  • Family structure determines how people relate.
    (Boundaries are the key)
  • Enmeshment
  • Disengagement

39
Summary
  • Symptoms can benefit a family by helping members
    avoid other issues.
  • Families pass through a predictable life cycle,
    and face predictable challenges related to each
    stage of developoment.
  • Resistance is normal and healthy. Dont fight it,
    but create a trusting relationship with the
    family and an environment that is comfortable.

40
Summary
  • Family stories or narratives can help the
    therapist understand how to intervene.
  • Gender roles and assumptions play a huge role in
    family distress.
  • Culture and ethnicity It is important to be
    respectful of these factors, but its also
    important to confront counterproductive beliefs
    and values regardless of their source.
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