Family Therapy
Modalities of Family Therapy Research - RKT
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In my SU-19_PSY3413-WA01A Substance Abuse and Addictive Behavior, with Professor D. Rutledge in Rochester University Psychology Accelerated Degree Program, Chapter 8,(8.4) "Working With Families", speaks of the 6 modalities of family therapy...
May this research enlighten you with ideas to empower...
Richard Kerry Thompson
Mr. T
RKT
The following is from the book.
Family therapy, like all other approaches to counseling, reflects divergent viewpoints. Each of the models can be useful to families affected by substance abuse, once they are ready for long-term changes.
Among the general approaches to family therapy that are frequently used for substance abuse treatment are the following:
(1) psychodynamic therapy,
(2) experiential/humanistic therapy,
(3) Bowenian family therapy,
(4) structural family therapy,
(5) communication models, and
(6) behavioral family therapy.
Each of these perspectives has a long history and exhibits unique characteristics. Yet each is built—although to varying degrees—on the notion that individual clients affect and are affected by their family units. Each examines the development of the individual in a social context. Each recognizes the potential inherent in interventions that go beyond individual, intrapsychic phenomena.
Lewis, J. A., Dana, R. Q., Blevins, G. A. (2015). Substance abuse counseling (5th Edition). Pacific Grove, CA:
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Psychodynamic Family therapy
Psychodynamic Family therapy
In 1970, the Group for the Advancement of Psychiatry attempted to put varying theories of family therapy into perspective by placing them on a continuum, with the two extreme positions indicating the degree to which a theoretical orientation tended to emphasize the individual or the family system.
Among the theoretical frameworks in common use, the psychodynamic approach may come closest to the position of emphasizing the individual. Psychodynamic family therapy, which is largely based on psychoanalytic thought, emphasizes the effects of individual pathologies on the family system, tends to view the family as a group of interlocking personalities, and stresses the importance of insight for personal change.
The psychoanalytic basis of this model is apparent in its emphases on bringing- ing unresolved conflicts to the surface, on dealing with past experiences, and on addressing both intrapsychic and interpersonal change. The psychodynamic viewpoint as it is applied to family practice has been strongly affected by systems thought and is therefore very different from analytic therapy as it is applied to individuals. The therapist tries to give clients an accurate understanding of their problems by counteracting defenses and converting dormant conflicts into open interpersonal exchange. Although psychodynamic family therapists stop short of labeling all individual symptoms as indications of system dysfunction, they recognize the high degree of reciprocity between individual and family problems and conflicts.
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Experiential/Humanistic therapy
Experiential/Humanistic therapy
The work of Virginia Satir (1967, 1972) has been closely associated with that of the communication theorists, but it can be placed in a category called experiential/humanistic therapy because of her concern for feelings and because of the strongly humanistic underpinnings of her approach.
To Satir ... the rules that govern a family system are related to how the parents go about achieving and maintaining their own self-esteem; these rules, in turn, shape the context within which the children grow and develop their own sense of self-esteem. Building self-esteem, promoting self-worth, exposing and correcting discrepancies in how the family communicates—these are the issues Satir tackles as she attempts to help each member of the family develop “wellness” and become as “whole” as possible. The humanistic influence of the human-potential movement on these goals is unmistakable. (Goldenberg & Goldenberg, 1985).
The process of family counseling, as practiced by Satir, focuses on the communication patterns that typify the functioning of the specific family. Among the dysfunctional communication styles that Satir has identified are those of the placater who always agrees with others at the expense of the self; the blamer, who dominates and accuses others; the super-reasonable person, who avoids emotional involvement and tends to intellectualize; and the irrel- evant person, who distracts others and communicates material that is out of context. In contrast to these dysfunctional communicators, the congruent communicator is able to express his or her messages clearly and genuinely; there is true congruence between what is meant and what is said, and what is felt and what is expressed. One of the primary goals of the family therapy of Satir and other humanistic theorists is to make congruent communication the norm for the family as a whole.
Closely associated with the family’s communication patterns are the self- esteem of the members and the rules that govern family interactions. Functional families reflect and enhance the self-esteem of individual members and are free to develop reasonably flexible rules that encourage open communication. Dysfunctional families, in contrast, fail to maintain the members’ self- esteem and tend toward rules that limit authentic communications. Therapy attempts to move family systems away from dysfunctional patterns and toward congruent, flexible, open transactions.
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Bowenian Family Therapy
Bowenian Family therapy
The approach developed by Murray Bowen places a unique emphasis on the differentiation of the self.
This concept is a cornerstone of the theory.... [It] defines people according to the degree of fusion or differentiation between emotional and intellectual functioning. This characteristic is so universal that it can be used as a way of categorizing all people on a single continuum. At the low extreme are those whose emotions and intellect are so fused that their lives are dominated by the automatic emotional system....
These are the people who are less flexible, less adaptable, and more emotionally dependent on those about them.... At the other extreme are those who are more differentiated.... Those whose intellectual functioning can retain relative autonomy in periods of stress are more flexible, more adaptable, and more independent of the emotionality of those about them. They cope better with life stresses, their life courses are more orderly and successful, and they are remarkably free of human problems. (Bowen, 1982)
Bowenian family therapy sees those who are less differentiated as being most likely to develop any type of emotional problem. Moreover, those who show low degrees of differentiation between emotion and intellect—the ones at the end of the continuum characterized by fusion—also show intense fusion in their marriages. People tend to choose partners with equal degrees of differentiation. Thus, two poorly differentiated individuals, each with a weak sense of self, will join together into a “common self” with a high potential for dysfunction.
According to Bowen, the poorly differentiated family will tend to be subject to one of several common symptoms: marital conflict, dysfunction in one spouse, or the projection of problems onto children. Whether these symptoms become serious—whether, for instance, the projection of problems onto children brings about impairment in one or more of the children—depends on the degree of stress with which the family must contend. If anxiety remains low, the family may remain reasonably functional. High anxiety levels bring more intense symptoms. Whether or not the family actually becomes dysfunctional, the potential for problems is transmitted through multiple generations, both because undifferentiated individuals have difficulty in detaching from their parents and because impaired children tend to marry other poorly differentiated individuals and pass their problems on to the next generation.
Just as anxiety affects the degree of fusion within the family, it also affects the working of triangles, which Bowen sees as the smallest stable relationship systems and therefore as the building blocks on which all human systems are based. The intensity of these triangles within the family is affected both by the degree of differentiation of self among the members and by the level of anxiety that is present.
Bowenian therapy, then, is based on the concepts of differentiation, of triangulation, and of multigenerational transmission processes. Therapists focus on modifying the central triangle in a family, on encouraging the process of differentiation, and on “slowly increasing intellectual control over automatic emotional processes” (Bowen, 1982). Gradually, the therapeutic process leads to the increased differentiation of each family member and therefore to the increased health of the family system as a whole.
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Structural Family therapy
Structural Family therapy
Salvador Minuchin (1974, 1979) has had a major impact on family practice through his development of structural family therapy, a strongly systems-oriented approach. In Minuchin’s terms, a family system can be understood only to the degree that its structure is observed and recognized. These patterned relationships regulate the family’s transactions, allowing the system to remain consistent over time.
Family subsystems form an important aspect of this structure. An enmeshed family system is characterized by an absence of clear boundaries between its subsystems and by a complete lack of distance among family members. In contrast, some family systems can be characterized as disengaged, the boundaries between subsystems are rigid, and personal distance among family members is great. The pathologically enmeshed family has overly rigid boundaries separating the family system from its environment, whereas the disengaged family may complement rigid internal boundaries with a lack of clear boundaries separating it from the outside world.
Family systems may be enmeshed or disengaged to varying degrees. What makes a structure dysfunctional is the family’s inability to change any of its behaviors in response to the necessity for a new adaptation.
Family members are chronically trapped in stereotyped patterns of interaction which are severely limiting their range of choices, but no alternatives seem possible.... Conflict overshadows large areas of normal functioning. Often one family member is the identified patient, and the other family members see themselves as accommodating his illness.... A family with an identified patient has gone through a reification process which overfocuses on one member. The therapist reverses this process. (Minuchin, 1979)
Minuchin’s therapeutic method begins with the counselor joining the family system, sharing and imitating its communication style, and taking a position of leadership. Once the counselor has elicited enough information to understand the family’s structure, the process of change begins. Gradually, the counselor confronts the family’s view of the problem by moving attention from the individual symptom-bearer to the family system, manipulating the subsystem boundaries, presenting alternate concepts of reality, and encouraging the family’s attempts to grow. Ultimately, the aim of the therapy is to change the structure of the family system, making it more functional in its own environmental context.
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The Communication Model
The Communication Model
If psychodynamic therapy differs from other models because of its emphasis on the individual, the communication model falls at the other end of the continuum through its emphasis on the system. Rather than adapting existing therapeutic models to family practice, the communication model was developed from a systems framework.
Much of the pioneering work in applying systems theory to the study of family relationships was begun in the 1950s by a group organized in Palo Alto, California, by Gregory Bateson.
Bateson’s work was instrumental in shifting the focus of family therapy from the single individual to the exchange of information and the process of evolving relationships between and among family members. It was also Bateson who stressed the limitations of linear thinking in regard to living systems.... He called instead for an epistemological shift—to new units of analysis, to a focus on the ongoing process, and to the use of a new descriptive language that emphasizes relationships, feedback information, and circularity. (Goldenberg & Goldenberg, 1985)
Bateson was joined in Palo Alto, in what was to become the Mental Research Institute, by Jay Haley, John Weakland, and Donald Jackson. This interdisciplinary team developed the double-bind theory of schizophrenic family relationships, hypothesizing that families with schizophrenic members tended to communicate through contradictory messages (Bateson, Jackson, Haley, & Weakland, 1956). As family therapy has evolved, the double-bind theory of schizophrenia has faded from view; more lasting has been the attention it focused on communication models for understanding families and other human systems. It is now readily understood that communications have both content and command aspects and that the command aspects, or Metacommunications, define relationships.
The communication approach is probably best exemplified by the strategic therapy of Haley (1976) and Madanes (1981), with its focus on active methods for changing repetitive communication patterns between family members. Haley suggests that “if therapy is to end properly, it must begin properly—by negotiating a solvable problem and discovering the social situation that makes the problem necessary” (1976, p. 9). If problems or symptoms serve some purpose in the social context, they can be resolved only through a strategy that focuses on interpersonal relationships.
Once the problem has been redefined in terms that make it solvable, the therapist develops a strategy unique to the needs of the specific family system. He or she then uses a variety of mechanisms, emphasizing the use of directives for families to follow between therapeutic sessions. One type of directive, the paradoxical directive, actually prescribes that a family member continues the behavior that would be expected to be targeted for change. The therapist redefines the symptom in terms of the function it serves and suggests that the behavior be continued or emphasized. If used very carefully, prescribing paradoxical tasks can help the therapist bring about change while avoiding resistance. To Haley, Madanes, and other communication theorists, the best way to eradicate the problem or symptom being addressed is to make it unnecessary for the stability of the family system.
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Behavioral Family Therapy
Behavioral Family therapy
Robert Liberman (1981) sees the family as a “system of interlocking, reciprocal behaviors” and points out that behavior is learned in a social context and maintained as long as the social system is organized to reinforce them.
Changing the contingencies by which the patient gets acknowledgment and concern from other members of his family is the basic principle of learning that underlies the potency of family or couple therapy. Social reinforcement is made contingent on desired, adaptive behavior instead of maladaptive and symptomatic behavior.
The counselor helps the family members identify the behavior that they view as maladaptive; target alternative goals; and find ways to reinforce the new, positive behaviors at the expense of the undesirable actions. Family members are also more likely to exhibit positive behaviors if they have observed them in practice. Therefore, modeling positive behavior is also an important aspect of the counselor’s role.
Liberman, like other family counselors using behavioral family therapy or social learning approaches, focuses attention on specific, measurable behaviors and on the environmental contingencies that tend to develop and maintain these behaviors. When behavioral therapists work with families, they set concrete goals to increase positive behaviors, at least in part by altering the patterns of reinforcement and the models offered by the social unit. Just as important is the counselor’s effort to provide skills training for family members, focusing on providing ways to communicate effectively, techniques for managing stress, and self-controlled methods to change behavior.
In the final analysis, all of these approaches to family therapy seek verifiable changes both in the behaviors of family members and in family relationships. Although the alternate perspectives vary in their emphases, they all recognize the importance of the family as a social system that both influences and are influenced by individual behaviors. Each of the approaches holds promise as a way to help family systems deepen and maintain changes that treatment can only set in motion