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Family Therapy Workshop

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????????????????????????. I. ????? Primary care. ???????????????????????? ... Behavioral exchange and rational bargains that lead to new social learning ... – PowerPoint PPT presentation

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Title: Family Therapy Workshop


1
Family Therapy Workshop
  • ??.??.????????? ?????????
  • ??????????????????? ????????????????????????
  • 11 ????????? 2548

2
????????????????????????
  • I. ????? Primary care
  • ????????????????????????
  • ??????????????????????????????????????????????????
    ??
  • ???????????????? ????? 2-3 ?????
  • ??????????????????????????????????????????????????
    ??????????????? (reflexive questions)
  • ?????????????????? ??? ?????????????????
  • ?????????????????????????? ??? ???????????????????

3
Family therapy
  • II. ????? Secondary or Tertiary care
  • Contact for change
  • Specific time-limited contact with whole family
  • About 6-10 one hour sessions using family therapy
    techniques
  • Focus on family interaction
  • Sophisticated hypotheses and formulations about
    family dynamics

4
Family treatment
  • Family treatment can be defined as a systematic
    effort to produce beneficial changes in a family
    unit by introducing changes into the patterns of
    family interactions. Its aim is the establishment
    of more satisfying ways of living for the entire
    family and for individual family members.

5
Family treatment
  • Family therapy might be thought of as any type of
    psychosocial intervention using a conceptual
    framework that gives primary emphasis to the
    family system and aims to affect the entire
    family structure.

6
Family Therapy in combination with pharmacotherapy
  • Although pharmacotherapy may be the cornerstone
    of treatment of axis I disorders, it should be
    combined with individual and family work for
    almost all patients, and with family therapy at
    some point in the treatment.
  • Reasons for this include the following
  • Family dynamic issues or other stress may
    precipitate episodes, and therapy can help
    families prevent or cope with further stress.
  • Persons with these disorders often have lost
    social skills, or the illness has created
    behavior patterns that make these persons averse
    to their support systems, including the family.

7
Family Therapy in combination with pharmacotherapy
  • Reasons for this include the following (???)
  • The illness has powerful effect on family life,
    and the entire family needs to cope with this
    fact together.
  • An ongoing relationship with the family therapist
    not only improves medication compliance but also
    provides continuous support during times when the
    person may not be on medication and provides a
    critical social support for persons dealing with
    what in many cases are chronic and potentially
    lifelong issues.

8
Assessing the familys coping mechanism in
PRACTICE
  • P Presenting problem (???????????????)
  • R Roles and Rules (????? ??? ???????
    ???????????)
  • A Affect (??????)
  • C Communication (??????????)
  • T Time in family life cycle (???????????????????
    ????????????)
  • I Illness (????????????)
  • C Community resource (???????????????)
  • E Environmental factors (???????????????????????
    ?)

9
?????????????? ????????? ????????????????
  • I. ????????????????? (Family Life Cycle)
  • II. ???????????? (Family System)
  • III. ???????????????? (Homeostasis)
  • IV. ???????????????????? (Family Structure)
  • V. ????????????????????????????? (Wider system)
  • VI. ???????????????????????????? (Stress on
    family)

10
I. ????????????????? (Family Life Cycle)
11
????????????????? (Family Life Cycle)
12
????????????????? (Family Life Cycle)
13
????????????????? (Family Life Cycle)
  • ?????????? (Transition) ??????????????????????????
    ????? ?????????????? ?????????????????????????????
    ??????????????????????????????????????????
    ??????????????????????????

14
II. ???????????? (Family System)
  • ???????????????????????????????????????????
    ????????????????????????????????
    ??????????????????????? ???????????????????????
    (homeostasis)
  • ????????????????????? (feedback)
    ????????????????????????????????
  • ???????????????????????????????????? (identified
    patient) ?????????????????????????????????????
    ?????????

15
III. ???????????????? (Homeostasis)
  • ???????????????? (Homeostasis) ???????????????????
    ????????????????????? ????????????????????????????
    ????????????? ????????????????????????????????????
    ??????????????????????? ??????????????????????????
    ???????????????????????????????????

16
???????????????? (Homeostasis)
  • ????????????????????????? (morphogenesis)
    ?????????????????????????????????????????? ????
    ?????????????????????? ??????????????????????????
    ???????????????????????????????????
    ????????????????????????????????????

17
IV. ???????????????????? (Family Structure)
  • ????????????????????? (Hierarchy)
  • ???????? (Subsystem) ?????? ??????????????
    (Parental subsystem), ??????????????? (Sibling
    subsystem)
  • ?????? (Boundary)
  • 1. ????????????? ??????? (Rigid boundary)
  • 2. ???????????????? (Diffuse boundary)
  • 3. ??????????????? ??????? (Clear boundary)

18
????????????????????? (Hierarchy)
  • ????????????????????? (Hierarchy) ?????????
    ???????????????????????????????????????????????
    ?????????? (power) ??????????????????

19
???????? (Subsystem)
  • 1. ???????? ??????? (marital subsystem)
  • ?????????? ????????????
  • ????????? ??????? ???????????????????????????
    (intimacy) ????????????????????????? (commitment)
  • 2. ?????????????? (Parental subsystem)
  • ?????????? ??????
  • ??????????????????????????????????? (child
    rearing), ?????? (guidance), ?????????????????????
    ????????????? (limit setting) ????????????????????
    ? (discipline)

20
???????? (Subsystem)
  • 3. ??????????????? (Sibling subsystem)
  • - ?????????????????
  • - ?????????????????????????
  • - ?????????????????????????? ?????????
    (negotiation), ?????????????????(cooperation),
    ?????????? (competition), ??????????????????????(m
    utual support) ??????????????????????????????
    (attachment to friends)

21
?????? (Boundary)
  • ???????????????????????? ?????????????????????????
    ??? ?????????????????????????????????????
  • ???????? 3 ????
  • 1. ????????????? ??????? (Rigid boundary)
  • - ?????????????????? ???????????????????????
    (minimal interaction or communication)
  • - ???????????????????????? (maximum privacy)

22
?????? (Boundary)
  • 2. ???????????????? (Diffuse boundary)
  • - ?????????????????????? (minimal privacy)
    ?????????????????????? (maximum interaction)
  • - ?????????????????????????????????????????
    (over involved)
  • 3. ??????????????? ??????? (Clear boundary)
  • - ??????????????????????????????
    ????????????????????????????????? ?????????
    ????????????????????????????????????

23
V. ????????????????????????????? (Wider system)
  • ??????????
  • 1. ???????????????????????
  • 2. ??????????????
  • 3. ????????????
  • 4. ????? ????????????? ??????
  • 5. ????? ???????? ???????? ????????????????? (???
    ????? ??????????? ???)

24
Wider system
25
VI. ???????????????????????????? (Stress on
family)
  • 1. ?????????? ????????? (horizontal stressors)
  • 2. ?????????? ?????????? (vertical stressors)

26
Horizontal and Vertical Stressors
  • Vertical Stressors
  • Family patterns, myths, secrets,
    legacies
  • ?
  • Time ?
  • Horizontal Stressors ?
  • Developmental
  • Life Cycle Transitions
  • 2. Unpredictable
  • Untimely death, chronic illness, accident

27
?????????????????? (Family assessment)
  • ???????????????????????????????? (family behavior
    pattern)
  • ?????????????????????????????????????????
  • ?????????????????????????????????? ??????
    ????????????????(circular question),
    ?????????????? (future question)
    ?????????????????????? (???????????? ??????????)

28
?????????????????? (Family assessment)
  • - ?????????? (Circular questions) ?? 3
    ????????????
  • 1. ?????????????????????????? ?????????????????
    ????????????(beliefs), ?????????? (feelings),
    ??????????? (behavior) ???????????????????????????
    ??
  • 2. ??????????????????(?????????????????????)
    ??????????????????????? ????????????????
  • 3. ?????????????????(empty chair)
    ?????????????????????????????? ?????????????

29
?????????????????? (Family assessment) (???)
  • 4. ?????????????? (Family genogram)
  • ????????????????????????? ???????????????
    ??????????????????? ??????????????????????????????
    ?????????????? ???????????????????????????????????
    ???????
  • ???? I.P. ????????????? Identified Patient
    ??????? ???????????????????????????????????????
    ???????????????????????????????

30
?????????????? (Family genogram)
  • I.P.

31
?????????????????? (Family evaluation)
  • I. ????????????????????????? ????????
    ??????????????????????????????????????????????????
    (current phase of family life cycle)
  • II. ?????????????????????????????
  • ?. ???????????????????????????????
  • ?. ????????????????????????????????????????
  • ????????? ??? ?????????????????????
    ????????????????????????
  • ?. ???????????????????????????????

32
???????????????????????????????
  • ??????????????????????? ??? ????????????
    (Composition and characteristics of the nuclear
    and extended family) ???? ????, ???, ?????,
    ???????? (????????????????????????????????????????
    ????? ?????????????????????????????????),
    ?????????, ????????????? ??? ??????????????????
  • ??????????????????????????????????
  • ?????????????????????????
  • ?????????????????????????????? ???????????
    (??????????????????)

33
?????????????????? (Family evaluation) (???)
  • ?. ???????????????????????????????????????
    ???????????????? ????????????????????????????????
  • ?. ??????????????????????????????????????????????
    ??????? ?????????????????? (strengths) ????????
    (motivations ) ????????????? (resistances)
    ?????????
  • III. ?????????????????????????????????????????
    (Formulating the family problem areas)
  • IV. ?????????????? ??? ?????????? (treatment
    contract)

34
  • ??? coffee break ???

35
Dysfunctional Family types of disturbances
  • Problematic family beliefs and myths
  • Individual symptomatology
  • Life cycle stressors
  • Inability of the family to accomplish family
    tasks

36
Family system explanations for symptoms
  • Symptoms
  • - May emerge as a result of problematic
    communication or interactional patterns in family
  • - May signal impasse at a particular
    developmental point in the familys life cycle
  • - May be part of solution behavior that is
    failing at its task
  • - May reflect problems in family structure and
    organization

37
Family system explanations for symptoms
  • Symptoms
  • - May be expressed when aspects of familys life
    are denied or dissociated
  • - May represent a lack of validation
  • - May be an expression of an underlying medical
    or psychiatric illness
  • - May simply relate to misfortune and bad luck

38
Family Therapy
  • Is any psychotherapeutic endeavor that
    explicitly focuses on altering the interaction
    between or among family members and seeks to
    improve the functioning of the family as a unit,
    or its subsystems and/or the functioning of
    individual members of the family.

39
Family Therapy The most common final goals
  • Reduction or elimination of symptoms or
    symptomatic behavior in one or more family
    members
  • Resolution of the problem as originally presented
    by the family
  • Increased family/marital intimacy
  • Role flexibility and adaptability within the
    family matrix
  • Toleration of differentness and differentiation
    appropriate to age and development level

40
Family Therapy The most common final goals
  • 6. Balance of power within the marital dyad and
    appropriate sharing of input and autonomy for the
    children
  • 7. Increased self-esteem
  • 8. Clear, efficient, and satisfying communication
  • 9. Resolution of neurotic conflict, inappropriate
    projective identification, and marital
    transference phenomena

41
Family Therapy Models
  • 2 basic forms
  • Insight-oriented family therapy
  • Behavioral family therapy

42
I. Insight-oriented family therapy approaches
43
Insight-oriented family therapy approaches
44
II. Behavioral family therapy approaches
45
Behavioral family therapy approaches
46
Structural Family Therapy
  • ????????????? Salvador Minuchin
  • ????????????????????????????????????
    ??????????????????????? ????????????????????
    ????????????????????? (boundary)
    ???????????????????????????????? (subsystem)
    ?????? ?????????????? ???????????????
    ????????????????????????????????(hierarchy)
    ????????????

47
Structural Family Therapy
  • ??????????????????????????????????????????????????
    ???????
  • Enactment ????????????????????????????????????????
    ????????????????????????????????????????????????
  • Reframing ????????????????????????????????????????
    ?????????? ???????????????????????????????????????
    ????????

48
Strategic Family Therapy
  • ?????????????????????????????????? Haley ????
    ?.?.1963 ??? Satir ???? ?.?.1967
    ?????????????????????????????? Metal Research
    Institute ?? Palo Alto ?? California
    ?????????????? Minuchin ?????.?.1974
  • Strategic Therapy ??? ????????????????????????????
    ??????????????????????????? ??????????????????????
    ?????????

49
Strategic Family Therapy
  • ??????????????????????????????????????????????????
    ?????????????????? ???????????????????????????????
    ??????? (solution) ??????????????????? (more of
    the same)
  • ??????????????????????????????????????????????
    (family rules) ??????????????????????
    (relationship patterns)???????????????
  • ??????????????????? ??????????????????????????????
    ?, ???????????????????????????????????????????????
    ? ????????????????????????????????????

50
Strategic Family Therapy
  • Haley ????????????????? (directives),
    ????????????? (task assignments),
    ??????????????????????????????????????????????????
    ????????? (paradoxical interventions)
    ????????????????????????????????????????
  • Madanes ????????????????????????????? paradoxical
    ??????????? pretend ?????? ??????
    ??????????????????????????????????????????????????
    ????????????????

51
Brief Family Therapy
  • Mental research institute in Palo Alto
  • Complete therapy within 10 sessions
  • Attended to the way a family solves its problems
    rather than to the reasons for the problem or the
    individual pathology
  • A communication-based approach founded in
    cybernetics
  • Practical and solution-oriented
  • Focus on the regulation of family patterns by the
    family rules

52
Brief Family Therapy
  • Milan school
  • Examines every aspect of the present relationship
  • Focus on the way each person tries to help the
    family
  • Both the Palo Alto group and the Milan school
    approaches also promote the idea of cotherapy and
    the use of the therapist teams, with in-room
    teams and teams behind one-way screens working
    together

53
Systemic Family Therapy
  • ????????????????????????????????????????
    ???????????? ?????.?.1978 ????????? 4 ???????
    Selvini-Palazzoli, Boscolo, Cecchin ??? Prata
  • ??????????????????????????????????????????????????
    ????????????????????????? (functioning of family
    system) ????????????????????????????????????
    (family ritual) ??????????????????? (hypotheses)

54
Systemic Family Therapy
  • ??????????????????????????????????????????????????
    ?? (breakdown of boundaries) ?????????????????????
    (parent subsystem) ?????????????? (child
    subsystem) ?.?. ???? ?????????????????????????????
    ?????????? ???????????????????????????????????????
    ?????????????????????????????
  • ??????????????????????????????????????????????????
    ?????????????????????????????????????? (family
    cohesion hypotheses)

55
Systemic Family Therapy
  • ??????????????????????????????????????????????????
    ??????????????????????????????????????
  • ??????????????????????????????? (circular
    question) ????????????????????????????????????????
    ??????????????????????????????????????? ?????????
    ?????????? ???????????? ?????????????????????????
  • ????????????????? (neutrality) ???????????

56
Systemic Family Therapy
  • ??????????????
  • ?????????????????????????? 5-8 ????? (sessions)
    ?????????? 10 ?????
  • ??????????????????????????? 1 ?????
    ?????????????????????????????????????
    (??????????????????) ??????????????????????
  • ????????????????????????? 1-3 ?????????????????
    ??????????????????????????????????????????????????
    ????????????????????? ??????????????? 4
    ??????????????????????????????????????????????????
    ??????????

57
Systemic Family Therapy ?????????????? (???)
  • - ????? 2-3 ??? ?????????????????????????????????
    ?????????????????????????? session ??? 1 ???
  • 1. ???????????????????????????????????????????????
    ???? ???? ??????????????? 1 ?????
  • 2. ??????????????????????????? ???????????????????
    ???? ?????????????????????????????????????????????
    ??????????????????????????????????????
  • 3. ?????????????????????????????????????????
    ?????????????????????????????????

58
Systemic Family Therapy ??????????????(???)
  • ??????????????????????????????????????????????????
    ???? (pre-session meeting) ?????? 15 ????
    ??????????? therapist ??? co therapist
    ???????????????????????????????????? 30-45 ????
    ????????????? (break) ?????? 15 ????
  • ??????????????????????????????????????????????????
    ????????????????????????????????????? (positive
    connotation ??? prescription) ????????????????????
    ?????????????????????????? ???????????????????????
    ??????????????????????????????????????????????????
    ?????????????

59
Systemic Family Therapy ??????????????(???)
  • ??????????????????????????? ?????? 15 ????
    ??????????????????????????????????????
    ???????????????????????????????????????? positive
    feedback ?????????????????????????????????????????
    ????? ????????????????????????????????????????????
    ????????????????????????????????????
    ?????????????????????
  • ??????????????????? (prescription)
    ???????????????????????? ?????? ??????????

60
Systemic Family Therapy ????????????????
  • ?????????????? ???????????????????????????????????
  • ??????????????????????????????????????????????????
    ???????????????????
  • ??????????????????????????????????????
  • ??????????????????????????????????????????????????
    ??????
  • ??????????????????????????????????????????????????
    ????????? ?????????????????????????

61
Basic strategies of family intervention
  • Supporting adaptive mechanisms, supporting and
    encouraging strengths, and imparting new
    information, advice, and suggestions
  • Expanding individual and family emotional
    experience
  • Explicit development of interpersonal skills,
    such as communication skills, parenting skills,
    and problem-solving skills

62
Basic strategies of family intervention
  • Reorganizing the family structure
  • Increasing insight and fostering intrapsychic
    conflict resolution
  • Helping the family find new and more positive
    ways of understanding their situation

63
Family treatment techniques
  • Reframing Therapist perceives and understands
    the patient's or the familys frame and counters
    this frame with another, competing view.
  • Enactment is the technique of eliciting the
    playing out of interpersonal problems the family
    complains of in the therapeutic hour.
  • Focusing ???????????? focus ?????????????????
  • Boundary making Therapist can make boundaries by
    verbal reconstruction, giving tasks, special
    rearrangements of seating in the sessions,
    nonverbal gestures, and eye contacts.

64
Family treatment techniques
  • Unbalancing techniques To change the
    hierarchical relationship of members of a family
    system or subsystem. There are 3 basic ways of
    unbalancing the family hierarchy and power
    distribution
  • Affiliating with certain family members
  • Ignoring family members
  • Entering into a coalition with some family
    members against others.
  • Creating s systemic reality Therapist helps the
    individual family member perceive themselves as
    acting and reacting to one another in the family.
  • Paradoxical techniques Most therapists reserve
    this type of intervention for more resistant
    couples.

65
Satirs Systemic Brief Therapy
  • ????????????? Virginia Satir
  • Iceberg metaphor?????????
  • ?????????????
  • Make contact ??????????
  • Explore listen to iceberg, not to a story
  • Set goals ??????????? level ??? iceberg
  • ??? intervention (??????????????????? iceberg
    ?????)
  • Anchoring ??????????? iceberg

66
Personal Iceberg Metaphor Behavior
  • Coping (stances)
  • Feelings
  • Feelings about feelings
  • Perceptions
  • Expectations
  • Yearnings
  • Self I am, life energy

67
Therapeutic process (Satir Model)
  • Make contact
  • Hope
  • Problems
  • Set Goals positive goals
  • Commitment
  • Explore
  • Change ??????? experiential
  • Anchoring
  • Closure
  • Homework

68
Psychoeducational Approaches
  • 3 main approaches
  • Parent Management Training
  • Relapse Prevention Training
  • Family Group Education

69
Expressed Emotion (EE)
  • ????????????? high EE ??????? ????????????????????
    ?????????? (high relapse rate)
  • ????????????????? high EE ??????????????
  • Critical (?????, ??????)
  • Hostile (?????????)
  • Emotionally overinvolved (??????????,
    ?????????????????????????????????????????????????)

70
Eclectic Approach
  • ????????????????????? ????????????????????????????
    ??????? ??????????????????????????????????????????
    ???????????????????? (simple short-term method)
    ??????????????????????????????????????????????????
    ???????????????????????????
  • ?????????????????????????????? ???????????????????
    ?????????????????????????????????????????
    ??????????????????????????????????????????????????
    ?????? ???????????????????????????????????????????
    ???

71
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