Family and Group Therapy

cybernetic theory

concerned with the mechanisms that regulate a system’s functioning and distinguishes between negative and positive feedback loops

positive feedback loops

amplify change and disrupt status quo

negative feedback loops

resist change and help a system maintain status quo

double-bind commuinication

when a person receives 2 contradictory messages from a family member and is not allowed to comment on the contradictions

symmetrical interactions

reflect equality and occur when the bx of one elicits a similar bx from another, “one-upmanship game”

complementary interactions

reflect inequality and occur when the bx of one complements the bx of another (e.g., dom-sub)

extended family systems therapy / intergenerational / transgenerational (bowen)

the transmission of certain emotional processes from one generation to the next is responsible for the development of schizophrenia in a family member

differnetiation

intrapersonal - a person’s ability to distinguish btw own feelings/thoughts

interpersonal - ability to distinguish btw own thoughts/feelings and other family

low levels lead to emotional fusion

emotional triangles

when a dyad has tension, recruits a third person to alleviate tension and increase stability

family projection process

parents’ projection of their emotional immaturity onto their children

multigenerational transmission process

transmission of emotional immaturity form one generation to the next

goal of extended family systems

increasing differentiation of one family member facilitates greater differentiation in others; use of a genogram; ask questions that are designed to defuse emotions and help family members identify how they contribute to family probs; have family members talk directly to them instead of each other

structural family therapy (minuchin)

a family members’ sxs are related to problems in the family’s structure, identifies subsystems and boundaries as important aspects of the structure

stable coalition

one parent and a child form an inflexible alliance against the other parent

unstable coalition (triangulation)

each parent demands the child side with them

detouring-attack coaliton

when parents avoid conflict by blaming the child for their problems

detouring-support coalition

when parents avoid their own conflict by over protecting the child

goals of structural family therapy

alleviate current sxs and change the family structure by altering coalitions and creating clear boundaries

phases of structural family therapy

joining, evaluation, intervening

joining

used to establish therapeutic alliance with family using 3 techniques

mimesis - adopting the family’s communication style

tracking - adopting the content of the content of the communication

maintenance - providing family members with support

evaluating

evaluating the family’s structure to make a structural dx and identify appropriate interventions; constructing a family map that depicts subsystems, boundaries, etc

reframing

relabeling a problematic bx so it can be viewed more constrcutively

unbalancing

used to alter hierarchical relationships and occurs when the therapist aligns with a family member whose level of power needs to be increased

boundary making

used to alter the degree of proximity btw family membersena

enactment

asking family members to role pay a problematic interactions so the therapist can observe and encourage an alternative way

strategic family therapy (haley)

assumption that struggles for power and control in relationships are core features of family functioning and that a sx is a strategy that is adaptive to the current situation for controlling a relationship when all other strategies have failed; assumes that power and control are determined by hierarchies within a family and that maladaptive functioning is due to unclear or inappropriate hierarchies

goals of strategic fmaily therapy

alter family interactions taht are maintaining its sxs; therapist assumes active role and aims to change bx rather tahn instilling insightstge

stages of strategic family therapy

social stage, problem stage, interactional stage, goal-setting stages

social stage

therapist welcomes the family and observes the family interactions

problem stage

therapist elicits each family members view of the family problem and its causes

interactional stage

family members discuss different views of the family’s problem and therapist observes their interactions

goal-setting stage

therapist helps family members agree on a definition of the problem and concrete goals to target the problem

straightforward directives

instructions to engage in specific bxs that will change how the family interactsparad

paradoxical directives

help family members realize that they have control over problematic bx or use the resistance of family members to help them change in the desired way

prescribing the symptom

instructing family members to engage in the problem bx in an exaggerated way

restraining

encouraging family members not to change or warning them not to change too quicklyord

ordeal

unpleasant task that a family member is asked to perform whenever they engage in the undesirable bx

milan systemic family therapy

assumption that the family as a whole protects itself from change through homeostatic rules and patterns of communication

dirty games

family games (family communication) associated with problematic bxs that are rigid and involve power struggles btw family members

goals of milan systemic family therapy

alter family rules and communication patterns that are maintaining problematic bx; providing the family with information that challenges family games and helps them develop communication patterns that increase the family’s ability to adapt to change; use of a therapeutic team and 5-part therapy sessions (presession, session, intersession, intervention, post session)

positive connotation

type of reframing that helps family members view a sx as beneficial because it maintains the family’s cohesion and well being

family rituals

designated to alter problematic family games

conjoint family therapy (aka human validation process model)

family systems seek a state of balance with family problems arising when balance is maintained by unrealistic expectations, inappropriate rules and roles, and dysfunctional communication

placating

agreeing with others due to fear, dependency, or desire to be loved

blaming

accusing and judging others to hide feelings of vulnerability and worthlessness

computing

taking an overly rational approach to avoid becoming emotionally engaged

distracting

changing the subject and making inappropriate jokes to avoid conflict

congruent (or leveling) style

functional style that is characterized by a congruence btw verbal and nonverbal messages, directness and authenticity, and emotional engagement with others

goal of conjoint family therapy

enhance the growth potential of family members by increasing their self-esteem, strengthening problem-solving skills, and helping communicate congruently; “use of self” is most important tool for the therapist

narrative family therapy

problems arise from oppressive stories which dominate ones life; stories are socially constructed; the problem - not the person - is the problem

goal of narrative family therapy

replace problem saturated stories with alternative stories that support more satisfying and preferred outcomes

emotionally focused therapy

used to help emotionally distressed partners who want to strengthen their relationship and stay together; contraindicated if they have different agendas or emotional vulnerability is not safe

assumptions of EFT

emotions are essential to attachment bxs, attachment needs are health and adaptive but problems arise when needs are enacted in the context of attachment related insecurities, relationship distress is maintained by the way interactions are organized and the dominant emotional experiences of each partner; dealing with emotions is the fastest and most effective way to solve problems

functional family therapy

for at risk adolescents, assumes problematic bxs within a family serve functions; goal is to replace problematic bxs with nonproblematic bxs that fulfill the same function

multisystemic therapy

for adolescents with serious clinical problems; individuals are embedded in and directly influenced by multiple systems

initial orientation, hesitant participation, search for meaning, and dependency stage

group members concerned with clarifying the nature of the group and depend on the leader for structure and answers

conflict, dominance, and rebellion stage

members compete for control, critical of each other

development of cohesiveness stage

conflict with group members decreases ad cohesiveness increases

therapseutic factors in group therapy

group cohesiveness, instillation of hope, universality, altruism, imparting information, development of socializing techniques, corrective recapitulation of the primary family group, interpersonal learning, imitative behavior, catharsis, and existential factors