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Family Therapy


Family Therapy Two Focuses The first is togetherness and the second is individuality. Too much togetherness creates fusion ... – PowerPoint PPT presentation

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Title: Family Therapy

Family Therapy
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Two Focuses
  • The first is togetherness and the second is
  • Too much togetherness creates fusion and prevents
    individuality, or developing one's own sense of
  • Too much individuality results in a distant and
    estranged family.

Differentiation of Self
  • The first concept is Differentiation of Self, or
    the ability to separate feelings and thoughts.
    Undifferentiated people can not separate feelings
    and thoughts when asked to think, they are
    flooded with feelings, and have difficulty
    thinking logically and basing their responses on
    that. Further, they have difficulty separating
    their own from other's feelings they look to
    family to define how they think about issues,
    feel about people, and interpret their
    experiences.Differentiation is the process of
    freeing yourself from your family's processes to
    define yourself. This means being able to have
    different opinions and values than your family
    members, but being able to stay emotionally
    connected to them. It means being able to calmly
    reflect on a conflicted interaction afterward,
    realizing your own role in it, and then choosing
    a different response for the future.

  • Triangles are the basic units of systems. Dyads
    are inherently unstable, as two people will
    vacillate between closeness and distance. When
    distressed or feeling intense emotions, they will
    seek a third person to triangulate.
  • Think about a couple who has an argument, and
    afterward, one of the partners calls their parent
    or best friend to talk about the fight. The third
    person helps them reduce their anxiety and take
    action, or calm their strong emotions and
    reflect, or bolster their beliefs and make a
  • This is a healthy triangulation!

  • People who are more undifferentiated are likely
    to triangulate others and be triangulated. People
    who are differentiated cope well with life and
    relationship stress, and thus are less likely to
    triangulate others or be triangulated.
  • Think of the person who can listen to the best
    friend's relationship problems without telling
    the friend what to do or only validating the
    friend's view. Instead, the differentiated person
    can tell the best friend "You know, you can be
    intimidating at those times..." or "I agree with
    you but you won't change your partner you either
    have to learn to accept this about them, or have
    to call this relationship quits...
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The Nuclear Family Emotional Processes
  • These are the emotional patterns in a family that
    continue over the generations.
  • Think about a mother who lived through The Great
    Depression, and taught her daughter to always
    prepare for the worst case scenario and be happy
    simply if things are not that bad. The daughter
    thinks her mother is wise, and so adopts this way
    of thinking. She grows up, has a son, and without
    realizing it, models this way of thinking. He may
    follow or reject it, and whether he has a happy
    or distressed relationship may depend on the kind
    of partner he finds.
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Emotional Process
  • Likewise, think of a daughter who goes to work
    for her father, who built his own father's small
    struggling business into a thriving company. He
    is seen in the family as a great business person
    as he did this by taking risks in a time of great
    economic opportunity. He teaches his daughter to
    take risks, "spend money to make money," and
    assume a great idea will always be profitable.
    His daughter may follow or reject her father's
    advice, and her success will depend on whether
    she faces an economic boom or recession.

Emotional Process
  • In both cases, the parent passes on an emotional
    view of the world (the emotional process), which
    is taught each generation from parent to child,
    the smallest possible "unit" of family (the
    nuclear unit). Reactions to this process can
    range from open conflict, to physical or
    emotional problems in one family member, to
    reactive distancing (see below). Problems with
    family members may include things like substance
    abuse, irresponsibility, depression....
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The Family Projection Process
  • This is an extension of The Nuclear Family
    Emotional Process in many ways.
  • The family member who "has" the "problem" is
    triangulated and serves to stabilize a dyad in
    the family.

Family Projection Process
  • Thus, the son who rejects his mother's
    pessimistic view may find his mother and sister
    become closer, as they agree that he is immature
    and irresponsible. The more they share this view
    with him, the more it makes him feel excluded and
    shapes how he sees himself. He may act in accord
    with this view and behave more and more
    irresponsibly. He may reject it, constantly
    trying to "prove" himself to be mature and
    responsible, but failing to gain his family's
    approval because they do not attribute his
    successes to his own abilities ("He was so lucky
    that his company had a job opening when he
    applied..." or "It's a good thing the loan
    officer felt sorry for him because he couldn't
    have managed it without that loan..."). He might
    turn to substance abuse as he becomes more and
    more irresponsible, or as he struggles with never
    meeting his family's expectations.

Family Projection Process
  • Similarly, the daughter who faces harsh economic
    times and is more fiscally conservative than her
    father is seen by the parents as too rigid and
    dull. They join together to worry that she'll
    never be happily married. She might accept this
    role and become a workaholic who has only
    superficial relationships, or reject it and take
    wild risks that fail. In the end, she may become
    depressed as she works more and more, or as she
    fails to live up to her father's reputation as a
    creative and successful business person.

Family Projection Process
  • The family member who serves as the "screen" upon
    which the family "projects" this story will have
    great trouble differentiating. It will be hard
    for the son or daughter above to hold their own
    opinions and values, maintain their emotional
    strength, and make their own choices freely
    despite the family's view of them.

The Multigenerational Transmission Process
  • This process entails the way family emotional
    processes are transferred and maintained over the
    generations. This captures how the whole family
    joins in The Family Projection Process, for
    example, by reinforcing the beliefs of the
    family. As the family continues this pattern over
    generations, they also refer back to previous
    generations ("He's just like his Uncle Albert -
    he was always irresponsible too" or "She's just
    like your cousin Jenny - she was divorced four

Sibling Position
  • sibling order, believing that each child had a
    place in the family hierarchy, and thus was more
    or less likely to fit some projections. The
    oldest sibling was more likely to be seen as
    overly responsible and mature, and the youngest
    as overly irresponsible and immature for example.
  • Think of the oldest sibling who grows up and
    partners with a person who was also an oldest
    sibling. They may be drawn to each other because
    both believe the other is mature and responsible.
  • Alternately, an oldest sibling might have a
    relationship with someone who was a youngest
    sibling. When one partner behaves a certain way,
    the other might think "This is exactly how my
    older/younger sibling used to act."

Emotional Cutoff
  • This refers to an extreme response to The Family
    Projection Process. This entails a complete or
    almost-complete separation from the family. The
    person will have little, if any, contact, and may
    look and feel completely independent from the
    family. However, people who cut off their family
    are more likely to repeat the emotional and
    behavioral patterns they were taught.

  • In some cases, they model the same values and
    coping patterns in their adult family that they
    were taught in their childhood family without
    realizing it. They do not have another internal
    model for how families live, and so it is very
    hard to "do something different." Thus, some
    parents from emotionally constrained families may
    resent how they were raised, but they do not know
    how to be "emotionally free" and raise a family
    as they believe other families would.

  • In other cases, they consciously attempt to be
    very different as parents and partners however,
    they fail to realize the adaptive characteristics
    of their family and role models, as well as the
    compensatory roles played in a complex family.
    Thus, some parents from emotionally constrained
    childhood families might discover ways to be
    "emotionally unrestrained" in their adult
    families, but may not recognize some of the
    problems associated with being so emotionally
    unrestrained, or the benefits of being
    emotionally constrained in some cases. Because of
    this, Bowen believed that people tend to seek out
    partners who are at about the same level of

Normal Family Development
  • optimal family development occurs when family
    members are differentiated, feel little anxiety
    regarding the family, and maintain a rewarding
    and healthy emotional contact with each other.

  • are balanced in terms of their togetherness and
    separateness, and can adapt to changes in the
  • view emotional problems as coming largely from
    the greater system but as having some components
    in the individual member
  • are connected across generations to extended
  • have little emotional fusion and distance
  • have dyads that can deal with problems between
    them without pulling others into their
  • tolerate and support members who have different
    values and feelings, and thus can support
  • are aware of influences from outside the family
    (such as Societal Emotional Processes) as well as
    from within the family
  • allow each member to have their own emptiness and
    periods of pain, without rushing to resolve or
    protect them from the pain and thus prohibit
  • preserve a positive emotional climate, and thus
    have members who believe the family is a good one
  • have members who use each other for feedback and
    support rather than for emotional crutches

Family Disorders
  • family problems result from emotional fusion, or
    from an increase in the level of anxiety in the
    family. Typically, the member with "the symptom"
    is the least differentiated member of the family,
    and thus the one who has the least ability to
    resist the pull to become fused with another
    member, or who has the least ability to separate
    their own thoughts and feelings from those of the
    larger family. The member "absorbs" the anxiety
    and worries of the whole family and becomes the
    most debilitated by these feelings. Families face
    two kinds of problems.

  • Vertical problems are "passed down" from parent
    to child. Thus, adults who had cold and distant
    relationships with their parents do not know how
    to have warm and close relationships with their
    children, and so pass down their own problems to
    their children.
  • Horizontal problems are caused by environmental
    stressors or transition points in the family
    development. This may result from traumas such as
    a chronic illness, the loss of the family home,
    or the death of a family member. However,
    horizontal stress may also result from Social
    Emotional Processes, such as when a minority
    family moves from a like-minority neighborhood to
    a very different neighborhood, or when a family
    with traditional gender roles immigrates to a
    culture with very different views, and must raise
    their children there. The worst case for the
    family is when vertical and horizontal problems
    happen at once.

  • The basic roles which I list below apply to
    American culture specifically, and Western
    Civilization generally - but with a few changes
    in details could be made to fit most any culture.
  • There are four basic roles that children adopt in
    order to survive growing up in emotionally
    dishonest, shame-based, dysfunctional family
    systems.  Some children maintain one role into
    adulthood while others switch from one role to
    another as the family dynamic changes (i.e. when
    the oldest leaves home, etc.)  An only child may
    play all of the roles at one time or another.  

"Responsible Child" - "Family Hero"
  • This is the child who is "9 going on 40."  This
    child takes over the parent role at a very young
    age, becoming very responsible and
    self-sufficient.  They give the family self-worth
    because they look good on the outside.  They are
    the good students, the sports stars, the prom
    queens.  The parents look to this child to prove
    that they are good parents and good people. As an
    adult the Family Hero is rigid, controlling, and
    extremely judgmental (although perhaps very
    subtle about it) - of others and secretly of
    themselves.  They achieve "success" on the
    outside and get lots of positive attention but
    are cut off from their inner emotional life, from
    their True Self.  They are compulsive and driven
    as adults because deep inside they feel
    inadequate and insecure.
  • The family hero, because of their "success" in
    conforming to dysfunctional cultural definitions
    of what constitutes doing life "right", is often
    the child in the family who as an adult has the
    hardest time even admitting that there is
    anything within themselves that needs to be

"Acting out child" - "Scapegoat"
  • This is the child that the family feels ashamed
    of - and the most emotionally honest child in the
    family.  He/she acts out the tension and anger
    the family ignores.  This child provides
    distraction from the real issues in the family. 
    The scapegoat usually has trouble in school
    because they get attention the only way they know
    how - which is negatively.  They often become
    pregnant or addicted as teenagers. These children
    are usually the most sensitive and caring which
    is why they feel such tremendous hurt.  They are
    romantics who become very cynical and
    distrustful.  They have a lot of self-hatred and
    can be very self-destructive.  This often results
    in this child becoming the first person in the
    family to get into some kind of recovery.

"Placater" - "Mascot" - "Caretaker"
  • This child takes responsibility for the emotional
    well-being of the family.  They become the
    families 'social director' and/or clown,
    diverting the family's attention from the pain
    and anger. This child becomes an adult who is
    valued for their kind heart, generosity, and
    ability to listen to others.  Their whole
    self-definition is centered on others and they
    don't know how to get their own needs met.  They
    become adults who cannot receive love, only give
    it.  They often have case loads rather than
    friendships - and get involved in abusive
    relationships in an attempt to "save" the other
    person.  They go into the helping professions and
    become nurses, and social workers, and
    therapists.  They have very low self-worth and
    feel a lot of guilt that they work very hard to
    overcome by being really "nice" (i.e. people
    pleasing, classically codependent) people.

"Adjuster" - "Lost Child"
  • This child escapes by attempting to be
    invisible.  They daydream, fantasize, read a lot
    of books or watch a lot of TV. They deal with
    reality by withdrawing from it.  They deny that
    they have any feelings and "don't bother getting
    upset." These children grow up to be adults who
    find themselves unable to feel and suffer very
    low self-esteem.  They are terrified of intimacy
    and often have relationship phobia.  They are
    very withdrawn and shy and become socially
    isolated because that is the only way they know
    to be safe from being hurt.  A lot of actors and
    writers are 'lost children' who have found a way
    to express emotions while hiding behind their

  • It is important to note that we adapt the roles
    that are best suited to our personalities.  We
    are, of course, born with a certain personality. 
    What happens with the roles we adapt in our
    family dynamic is that we get a twisted,
    distorted view of who we are as a result of our
    personality melding with the roles. This is
    dysfunctional because it causes us to not be able
    to see ourselves clearly.  As long as we are
    still reacting to our childhood wounding and old
    tapes then we cannot get in touch clearly with
    who we really are. 

  • The false self that we develop to survive is
    never totally false - there is always some Truth
    in it.  For example, people who go into the
    helping professions do truly care and are not
    doing what they do simply out of Codependence. 
    Nothing is black and white - everything in life
    involves various shades of gray.  Recovery is
    about getting honest with ourselves and finding
    some balance in our life.   Recovery is about
    seeing ourselves more clearly and honestly so
    that we can start being True to who we really are
    instead of to who our parents wanted us to be. 
    (Reacting to the other extreme by rebelling
    against who they wanted us to be is still living
    life in reaction to our childhoods. It is still
    giving power over how we live our life to the
    past instead of seeing clearly so that we can own
    our choices today.) The clearer we can see our
    self the easier it becomes to find some balance
    in our life - to find some happiness,
    fulfillment, and serenity.

Goals of Therapy
  • reframing the presenting problem as a
    multigenerational problem that is caused by
    factors beyond the individual
  • lowering anxiety and the "emotional turmoil" that
    floods the family so they can reflect and act
    more calmly
  • increasing differentiation (individuality),
    especially of the co-dependent, so as to increase
    their ability to manage their own anxiety,
    transition more effectively into a healthy
    relationship with the addict, and thus fortify
    (strengthen) the entire family unit's emotional
  • using the therapist as part of a "healthy
    triangle" where the therapist teaches the family
    to manage their own anxiety, create distance and
    closeness in healthy ways
  • focusing away from "the problem" and including
    the overall health and happiness of the family.
    Thus creating positive habits and interests
  • evaluating the progress of the family in terms of
    how they function now compared to when they
    started, as well as how adaptive they can be to
    future changes
  • addressing the power differential in families
    such as economic power and gender role

  • In general, the therapist accomplishes this by
    giving less attention to specific problem they
    present with, and more attention to family
    patterns of emotions and relationships, as well
    as family structures of dyads and triangles.
  • tries to lower anxiety to promote understanding,
    which is the critical factor in change open
    conflict is prohibited as it raises the family
    members' anxiety during future sessions
  • remains neutral and detriangulated, and in effect
    models for the parents some of what they must do
    for the family
  • promotes separation of members, as often a single
    member can cause changes in the larger family
    using "I" statements is one way to help family
    members separate their own emotions and thoughts
    from those of the rest of the family
  • develops a personal relationships with each
    member of the family and encourages family
    members to form stronger relationships too
  • encourages cut off members to return to the
  • may use descriptive labels like "pursuer
    (co-dependent)-distancer (addict)," and help
    members see the dynamics occurring following
    distancers only causes them to run further away,
    while working with the pursuer to create a safe
    place in the relationship invites the distancer
  • coaches and consults with the family, interrupts
    arguments, and models skills..

Techniques Getting the environment right 
  •  Counseling techniques   
  • create a space to talk which is private and quiet
    and where you know you will be free from
    interruptions (always seek the advice of a
    colleague about the safety and appropriateness of
    this action).  Where possible, make sure the
    seating is comfortable and make sure that there
    is appropriate heating and ventilation.
  • Get the message across that you have time to
    attend to the issue that you want to address.
     Get the message across that the conversation is
    private and that you will not be passing on what
    the family says to any third party.
  • You have to also make it clear that if the
    family gives you information that suggests that
    they or others are in danger (for example a
    disclosure of abuse or threat of self-harm) you
    cannot keep this confidential.  Make sure that
    you are fully aware of your organisations child
    protection policies

Getting the listening right 
  • One way of encouraging a person/persons to talk
    is to make sure that they know you are listening.
  • You can do this by just being attentive and by
    showing with your body language that you are
  • Sometimes this will be by facing the person and
    making good eye contact.  
  • Sometimes sitting side by side will be less
    threatening.  Try not to interrupt when the
    person is talking. 
  • By occasionally nodding or quietly saying "yes"
    or "aha" the person should be encouraged to open
  • Reporting back to the person/family a short
    summary of what they have just said and asking
    them if you have got it right is another way of
    doing this. 
  • Make sure you look and sound calm, unhurried and

Reflective Listening
  • S "I'm very depressed today, Doctor."D "You're
    very depressed, Mr. Smith."S "Yes. I haven't
    been this depressed in a long time."D "You
    haven't been this depressed in a long time."S
    "I'm so depressed that I'm thinking about killing
    myself."D "You're thinking about killing
    yourself."S "I'd like to kill myself right
    now."D "You'd like to kill yourself right
    now."S "Yes, I'm so desperate that I think I'll
    open this window and jump out."D "You're
    thinking of jumping out that window."S "I'm
    gonna do it. See? I'm opening the window.... and
    I'm gonna jump."D "You're going to jump out the
    window."S "Bye, doc. Here I go........
    aaaaaaaaaaaaaaaaaaaaah" (splat)D
    "Aaaaaaaaaaaaaaaaaaaaaah, splat."

Asking the right questions 
  • Try to ask more open questions than closed
  • An open question is one which cannot be answered
    with yes or no and which encourages a more
    detailed answer, for example
  • What are your feelings about this?
  • What are the advantages of doing things the way
    you have suggested?
  • What are the disadvantages?
  • Avoid closed questions such as
  • Are you sad?
  • Are you looking forward to the holidays?
  • Another disadvantage of closed questioning is
    that the desired answer might be implied within
    the question and you might inadvertently steer
    the person to give an answer that they wouldnt
    otherwise have given.  An example of this would
  • Are you going to stop obsessing about your
    addicted family member because it is upsetting
    you so much?
  • The implied expected answer here is quite clearly

Being affirming   
  • To encourage the flow of conversation it is
    important that you show respect by taking an
    accepting attitude. 
  • The message you are trying to get across is "I
    have respect for your opinions and your view of
    the world at this present time". 
  • This is not the same as saying that you agree
    with the clients opinions or actions and it is
    okay for you to make it clear that your opinions
    and moral view are different, as long as this is
    done in a respectful way.

How to make it work
  • Do not turn your conversation into an
  • However good you are at counseling some people
    will not be ready to talk to you or want to talk
    to you.  
  • This does not mean that you have failed.  It
    might be that they will talk later or that they
    will talk to a colleague of yours who they know
    better or a colleague of the opposite sex.  

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