FINAL STUDY GUIDE

LOOK AT FACTORS THAT INFLUENCE CLIENT OUTCOME AND ATTACHMENT THEORY

General Systems Theory

DEVELOPED BY: Ludwig von Bertalanfy

•Any system—whether biological, mechanical, social, or ecological—can be understood by examining the interactions and relationships among its components rather than just the individual elements themselves

•Its possible to apply universal principles to all kinds of groups of phenomena – machines, the cosmos, families

Circular Causality

•family is viewed as an interconnected system where each member’s behavior affects and is affected, by others. Focus on relationships and interactions within the family rather than individual behavior in isolation.

EX: Parental marital conflict is impacting Alex’s ability to sleep and focus on his academics. His academic struggles divert his parent’s attention from their relational issues to focus on Alex’s academic issues. They put pressure on Alex to get his act together so as to do well on state tests.

Homeostasis

Systems maintain a drive for stability or the systems tendency toward a stable status.

“Dysfunctional” behavior could be understood and appreciated if it maintains __________

• families have a “range of comfort” so there tendency is to resist change

• the goal is to keep the family intact

Morphogenesis

•allows for system-enhancing behaviors such as creativity and innovation that allow for growth in the context of stability.

AKA. sees the change trying to come in and allows it to change.

Morphostasis

• is similar to homeostasis but reflects stability of the system within in the context of change or challenges (structural constancy).

AKA. reflects the stability of the system when change is trying to occur

Boundaries

•Determined by how much information is permitted within and between systems indicates the openness or closedness of a system

Open = If the system accepts too much information, the boundaries of the family become indistinct from other systems.

Closed = If the boundaries are too rigid, the system lacks the flexibility to effectively process information from its environment.

_______ may be rigid, flexible, or diffused

Hierarchies

a system of organizing people into different ranks or levels of importance

power!

Subsystems

a system that is part of a larger system

Cybernetics

•The study of self-regulating systems

•Systems regulate themselves through feedback loops

•The interrelatedness of the family, which is governed by rules, sequences, and feedback

•Assumption: If there is a pattern of behavior that exists over time, it is maintained by a feedback loop

Structure

The way in which a family is designed to look and act

• what is in place to hold the fort in a certain way?

Feedback Loops

Positive = enhances or amplifies changes; this tends to move a system away from its equilibrium state and make it more unstable. (amps Morphogenesis)

Negative = dampen or buffer changes; this tends to hold a system to some equilibrium state, making it more stable or contributes to its rigidity. (amps Morphostasis)

IN GENERAL _____ ______ influence how a family responds to changes and behaviors within the system

Rules

define patterns of interaction

• who can say what to whom

Roles

the part the a family member plays within their unit

Entropy

Lack of information in a system which causes disorder (emphasizing closed systems)

• negative influence on the family

All systems need useful energy inputs…this term does not allow that

Negentropy

refers to the utilization of new/useful information which increases stability, order, and growth (emphasizing openness of a system to a degree)

All systems need useful energy inputs to increase Negative Entropy!

Equifinality

ALL ROADS LEAD TO ROME!

• the same outcome can be reached through different paths

  • belief that the use of different theoretical models and interventions often result in a given end goal or outcome

• focused on the relational, interactional, patterns and the process

Digital/Analog Communication

Digital = VERBAL COMMUNICATION

• least powerful element of communication

Analog = NONVERBAL COMMUNICATION

• nonverbal tells more information and what to do with the verbal message

Content VS. Process

Content = What is said in conversations

Process = How people are communicating

• What might come up for the person receiving the content? (a good way to think of process)

•Family therapy focuses on the process of communication

• Rarely is it about content (exceptions: infidelity, abuse, violence, suicide, homicide ect)

Autopoiesis

self-generation: a concept borrowed from biology that describes a system’s ability to self-create and maintain itself

Self-Referencing Processing:

• Families process information and respond to situations based on self-referential systems, meaning they interpret and react based on their internal framework, not purely on the external event itself

Change comes from Within:

• According to ___________, these disturbances do not dictate the family’s response. Instead, the family's internal structure (e.g., problem-solving patterns, emotional regulation, adaptability) will determine whether it responds with resilience, denial, conflict, or adaptation.

Social Constructionism

emphasizes that social realities are actively created and shaped through social interactions, meaning individuals have agency in shaping their world, not just being passively determined by structures. 

EX: A theory that the concept of "gender" is not fixed but is socially constructed through interactions and expectations within a society!

epistemology

__________ = is the study of knowledge and how we acquire knowledge

Objectivism = __________ refers to the belief that reality exists independently of any individual's thoughts, perceptions, or beliefs. In other words, objects exist objectively,

Subjectivism = What one person believes to be true may differ significantly from what another believes because each person’s truth is filtered through their subjective experiences and interpretations.

Constructionism = Objectivism and subjectivism are contrasting ______________ approaches to understanding how knowledge is created and validated. They represent two ends of the spectrum in terms of how we perceive reality, truth, and the process of knowing.

Feedback as part of the therapy relationship

In second-order cybernetics, feedback is not just a mechanical or informational loop but a relational process. It is about how communication and interactions between the therapist and the client INFLUENCE the therapeutic system

Therapist is a Part of the System: •: Therapists are not neutral observers but active participants in the therapeutic system. Their interventions, questions, and even their presence contribute to the feedback loop. This requires therapists to engage in self-reflection and consider how their actions influence the therapeutic process, continuously adjusting their approach based on feedback from the client.

Nonpurposeful Drift

1. Lack of Intentionality: Changes occur without conscious planning or acknowledgment, often as reactions to immediate circumstances rather than deliberate choices.

2. Gradual Process: The shift is slow and often unnoticed until it has significantly impacted family functioning.

3. Reactionary Nature: Changes result from reacting to daily stresses, needs, or crises rather than proactive decision-making.

4. Loss of Alignment with Family Values or Goals: As drift continues,family actions and interactions may no longer align with the fam

Results of ongoing, random, or non-linear interactions within the system and with its environment.

• In other words, systems do not have an inherent "purpose" guiding them; instead, they adapt and transform as they encounter new situations, feedback, and influences.

Reality as a multiverse

“Multiverse" represents the idea that within any family, there are multiple overlapping and sometimes conflicting perspectives or versions of reality. Each family member’s internal world is a separate universe that influences and is influenced by others. Reality is not a single, unified truth but a complex network of perceptions, beliefs, and emotional experiences.

Viewing the family as a multiverse emphasizes that the family's functioning is not just about individual actions but also about the interactions between these varied subjective realities. This approach encourages therapists to explore and validate each family member's perspective, promoting understanding and empathy.

structural coupling

Describes how a system (e.g., an individual or a family) and its environment influence each other reciprocally.

_______ ________ explains how open systems maintain a relationship with, and adapt to, their environment while retaining their internal coherence and organization. Compatibility or fit between systems. It refers to the degree in which systems are able to co-exist.

consensual domains

_______ _______ refer to the shared space of meaning, understanding, and behavior that emerges when two or more individuals interact and coordinate their actions.

•Importance of Language: Language plays a crucial role in forming ______ ______. Through communication, individuals negotiate and establish SHARED meanings, which guide their interactions. Language is not just a tool for transmitting information; it is a means of creating and maintaining the ______ ______ by aligning perceptions, emotions, and intentions.

•Family systems: ______ ______ reflect how family members co-create SHARED realities, roles, and patterns of interaction through their continuous communication and relationships. The family's _______ ______ encompasses the implicit and explicit rules, rituals, and meanings that guide their behavior, often without conscious acknowledgment by the members.

Self-Observation and Reflexivity

Self-reference involves _________, where individuals or systems reflect on their own functioning. In therapy, this ________ is important as it allows both the therapist and the client to examine their roles within the therapeutic system

Therapists use self-reference to monitor their biases, assumptions, and influence on the process,

while Clients engage in self-reflection to understand how their thoughts, emotions, and behaviors are shaped by their internal narratives and external interactions.

The Modern Terminology:

general systems theory, circular causality, homeostasis, morphogenesis, morphostasis, boundaries, hierarchies, subsystems, cybernetics, structure, feedback loops, rules, roles, entropy, negentropy, equifinality, digital/analog communication, content vs. process.

The Post-Modern Terminology:

Autopoiesis, social constructionism, epistemology (objectivism, constructivism, subjectivism), feedback as part of the therapy relationship, nonpurposeful drift, reality as multiverse, structural coupling, consensual domains, self-observation and reflexivity

Founders of Family Therapy

Kurt Lewin

Freud and Adler

John Bowlby

Nathan Ackerman

Tavistock

Jay Haley and Don Jackson

Gregory Bateson

Haley, Weakland, Fry, and Jackson

Virginia Satir

Theodore Lidz

Lyman Wynne

Murray Bowen

Carl Whitaker

Salvador Minuchin

Ivan Boszoermenyi-Nagy

LESS KNOWN FIGURES: John Bell, Peter Laqueur, Robert McGregor

History of Family Therapy Emerging:

•A whole new way of understanding and explaining human behavior.

•Developed by a diverse group of courageous scholars representing a multitude of disciplines.

•Proposed that psychological problems were developed and maintained in the social context of the family.

•Relocated the responsibility for the problems and the focus of treatment from internal world of the individual patient to the entire family.

•Proposed a new way to understand and explain emotional distress.

(WWII helped direct the emergence of family therapy and systems because it delayed marriage and hasty wartime marriages, the baby boom happened after it was done, changing sexual mores, wider acceptance of divorce occurred)

Kurt Lewin

•Conceptualization that a group is more than the sum of its parts

•Group discussions were more effective than lecturing to promote change

•Behavior change requires ‘unfreezing’ – shaking up the system

•Role theory – what is your role?

•Complex and dynamic

•Distinction between process and content

•What is said vs how it is communicated

•Importance of here and now interactions

Freud and Adler

Created the CHILD GUIDANCE MOVEMENT

•Psychological disorders were result of unsolved childhood problems 

•Early Intervention prevents future mental illness

•Child Guidance workers concluded the problems were the result of family tensions rather than the child’s symptoms

•Maternal overprotectiveness

•Schizophrenogenic mother

John Bowlby

•Conducted conjoint interviews

•Researched parent-child relationships

•Developed attachment theory

(this researcher further discussed the importance of family: family therapy as a catalyst, primary focus still individual)

Freud

introduced idea that problems may stem from childhood

Adler

introduced relational aspects

• counseled teachers and families

• Child Guidance

Nathan Ackerman

The FIRST to use family therapy as a primary modality of change

Tavistock

• established Family Psychiatric Unit

• Focus on Object Relations Theory

• Divorce courts sent potentially divorcing couples to centers to attempt reconciliation

Jay Haley and Don Jackson

• focused on patterns of communication

• ideas were popular and merged into family therapy

Bateson, Haley, Weakland, Fry, and Jackson

THE PALO ALTO GROUP

•Developed a theory of communication to explain the development of schizophrenic behavior within the familial context

•Hypothesized that symptoms served a homeostatic function within the family

•Served as a springboard for the development of the field of family therapy

Gregory Bateson

British anthropologist and social scientist married to the famous cultural anthropologist Margaret Mead

• part of the Palo Alto group

• Grant to study nature of communication

• metacommunication = covert form of communication, goes unnoticed

• (report and command)

CREATED DOUBLE BIND

• which is a second command that is more abstract conflicts with the first and is also followed by a punishment

• “damned if you do, damned if you don’t”

Theodore Lidz

Yale professor of psychiatry who studied causes of schizophrenia

•Rejected premises that maternal rejection was core feature of schizophrenic families. Fathers could also be destructive.

•Focused instead on the marital relationship

•Role reciprocity (cooperative roles)

•Not enough to fulfill own role, must balance role with partner to be an effective pair – again the whole is greater than sum of parts

•Found two types of patterns in marital relationships

• Marital Schism = husbands and wives undermine each other to gain favor with their children. Marriages tend to be conflictual, volatile, and a “back and forth.” More overt

• Marital Skew = one person dominates the other. One passive partner (e.g. denial of partner characteristics) and one dominant partner. Children are torn by conflicting allegiances to each partner; are aware of power differential. More covert

Lyman Wynne

Psychiatrist and psychologist University of Rochester School of Medicine

•Observed unusual patterns in hospitalized families

•Odd emotional qualities and the boundaries around them

•Pseudomutuality: façade of harmony, committed to being together, enmeshment, no individuality. Generally, have deeper issues that are not tolerable such as family secrets, poor relationships, or individuality

•Pseudohostility: family members collude with each other to obscure and impinge on autonomy, distorts communication, and intimacy. Frequent conflict and bickering

•Rubber Fence

•Allows for external interaction (e.g. school) but snaps back if there is too much outward extension. Protects familial isolation

•Disordered Communication

•Distinguishing characteristic of families with young adults who have schizophrenia

Less Known Figures INFORMATION:

John Bell:

•Probably the first one to do family therapy

•Family group therapy

•Three stages of therapy: child centered, parent centered, family centered

•Did not train students or programs and did not establish a center

Peter Laqueur:

•Multiple group family therapy (ex: family week)

•Psychodrama techniques

Robert McGregor:

•Multiple impact therapy (system and subsystem assessment): no longer used but led to development of experiential family therapy

Palo Alto Group

•Bateson was the researcher, Haley and Jackson more clinically important to development of MFT

•Satir was also involved but branched off

•Assumption: Psychiatric problems are a consequences of poor interactions

•Homeostasis was a centerpiece of early work (Jackson)

• Now recognized that family resistance to change was overestimated

• At time helped clinicians better understand family dynamics

Don Jackson

(This researcher focused on what relationships could produce in roles of members)

•Complementarity Relationships

• Partners are different in ways that fit together (e.g. jigsaw puzzle)

• Maximize differences between the spouses

• Can be an initial spark of attraction but also point of contention later on

• Can be reflective of personal experiences, culture, personality structure

  • One partner has cognitive strengths and the other has emotional strengths

•Symmetrical Relationships 

• Relationships are based on similarity.

• Minimization of differences between people; homogamy

• Similarity can be attractive; similar values, interests and easy to develop connection

• Inevitable differences between partners can have greater impact on disappointment

Family Rules = within any relationship there are redundant patterns of interaction (aka. rules)

Scapegoating = families need a sick family member rather than symptoms serve a purpose

Jay Haley

•There are different levels of communication

• There are multiple messages within every form of communication

• Symptoms arise from incongruence among the different levels

•Don’t reason with clients; play a game of cat and mouse

• Tells client to disclose problems they feel comfortable disclosing and maintain the secrets they do not wish to disclose (what clients would do anyways)

•Understand possible function of client’s symptoms as well as context in which they occur

•Directive: getting clients to do something about their problems

• Prescribing the symptom

Virginia Satir

interested in communication (like Haley, Jackson, and Bateson)

• BUT was MORE FOCUSED on emotional communication

_______ Focused on Family Roles:

• •Victim, placatory, defiant one, or rescuer

  •Roles sucked self esteem and constrained options

  •Focused on the individual role in the family

Focused on positive interactions

Murray Bowen

•Psychiatrist specializing with schizophrenics

• Often hospitalized entire families

•Much of work focused on theory

• Core idea was differentiation of self

• Triangle: smallest unit of a stable relationship

• Transgenerational perspective: Family of Origin impacts current functioning

•Focused on remaining objective and not becoming a part of family’s emotional reactivity

• Getting triangulated

• Focus on diffusing emotional family triangles

Carl Whitaker

•Psychotherapy of the absurd and pioneer in co-therapy

•Intertwined support and emotional provocation

•Did not use structured strategy or specific techniques

• Let unconscious run therapy (sometimes even fell asleep in session)

•Developed experiential therapy

• Intuitive, active participation, in session change

• Assumption: problems caused by lack of awareness of feelings, rigidity in response to problems, and denying impulses

Salvador Minuchin

•Known for compelling ways to interacting with families

•Developed structural family therapy

•Observed two primary patterns of familial interaction

• Enmeshed: chaotically intertwined

• Disengaged: emotionally unengaged

•Systemic repercussions for individuals behaviors

• Over-involved mothers will futilely engage with their children (because involvement is problem, not interactions), but mother has to be overly engaged because father is disengaged

•Change structure of family

• First order change: change specific behavior

• Second order change: reorganize family system

Ivan Boszormenyi-Nagy

•Pioneer of Contextual Theory

•Developed concepts on relational ethics

• people's expectation of fairness and reciprocity is a major determinant of close relationships

Boundaries and Feedback Loops

1.Feedback loops can reinforce existing boundaries

2.Feedback loops can support flexible boundaries

3.Flexible boundaries promote adaptive feedback loops by allowing healthy communication and emotional exchange

4.Disrupting a feedback loop can lead to boundary adjustments and create new patterns of communication and interactions

Ecology

is the science that attempts to describe the reciprocal relationship between living organisms, including humans, and their environment.

(interactions within and between the different environments of a family make up the _______ of the family)

stresses that development is affected by the setting/environment

Urie Bronfenbrenner

Created the Ecology of Human Development by Nature and Design

Darling argues that ______________ early work focused on context, but his later work focused on the patterning and interrelationship of multiple determinants of development and on the active role of the developing person

_____________ saw that the child was ACTIVE in their development as they grew

Bronfenbrenner’s Ecological Model Settings:

Microsystem

Mesosystem

Exosystem

Macrosystem

Chronosystem (which was added later)

Microsystem

a child’s direct interactions with family, school, peers, etc.

Mesosystem

interconnections between the microsystems, such as parent-teacher, family and church, family and neighborhood, etc.

Exosystem

Indirect influences on a child’s development, such as parental workplace policies

Macrosystem

Overarching values, ideologies, societal norms, cultural beliefs, and laws that make-up the blueprint of society

Chronosystem

The dimension of historical time, reflecting changes over life.

Vertical Stressors

These are multigenerational in nature and include family history, patterns , and legacies that are passed down.

Examples include family trauma, unresolved grief, or cultural expectations.

These stressors impact how a family handles current stress and shape the family’s capacity to respond to new challenges

Horizontal Stressors

These stressors are related to the events that happen over time, such as transitions in the family life cycle or unexpected crises.

These stressors affect the current family system and require adaptation to new roles or circumstances (e.g., marriage, the birth of a child, the death of a parent). Developmental, historical, unpredictable!

Complexity View

posits rather than viewing each level - biological, psychological, and social - as separate and independent, this term acknowledges that these levels constantly interact in a non-linear and reciprocal manner.

______ ______ = reciprocal/recursiveness of biological, psychological, and social factors

George Engel (who created the biopsychosocial model) believed that the BIOMEDICAL MODEL was responsible for dehumanized care with (?) CRITICISMS:

3!

Dualism

Reductionism

Detached Observer

Dualistic Nature (Dualism)

with the separation of body-as-machine and the narrative biography and emotions of the person where physicians were encouraged to focus on the disease to the exclusion of the person who was suffering.

Reductionist Orientation (Reductionism)

is of medical thinking that anything that could not be explained at the cellular or molecular process was ignored or devalued resulting in a technical and impersonal style of clinical practice.

Influence of the Observer on the Observed (Detached Observer)

•Engel understood that one cannot understand a system from within without disturbing the system in some way. Human dimension of the physician and the patient is an important focus of scientific study. Cannot assume a stance of pure objectivity: example is the ‘white coat effect’.

“If I’m watching you and you know I’m watching you, you will change your behavior”

Structural Causality

•examines a hierarchy of unidirectional cause and effect relationships

•________ models guides practical actions

•Where and how do we intervene? What factors influence that decision?

“We can’t fix all these areas that need interventions so WHERE can you intervene and it be appropriate”

EX: You can’t fix poverty! But maybe you can give medicine or therapy

Biomedical Model

A scientific measure that is taken by physicians to find out the reason behind a particular disease. The application to medicine where the sole focus is on the biological reasons to learn about the illness and offer treatment.

•It does not include the patient and his/her attributes as a person, as a human being, or the impact of the relationship between the physician and patient

Biopsychosocial Model

George Engel created this model

•to understand and respond appropriately to patient’s suffering, clinicians must simultaneously attend to the biological, psychological, and social dimensions of illness.

•He suggested a holistic, contextually-based, compassionate approach to medical practice.