Family Therapy – Comprehensive Review

These flashcards cover key definitions, theories, founders, techniques, and goals across systemic, structural, strategic, and emotionally focused family therapy, along with nursing considerations.

What is the definition of family therapy?

A psychotherapeutic endeavor that focuses on altering interactions between and among family members to improve relationships and overall functioning.

What is the current focus of most family-therapy models?

Interpersonal relationships, with specific strategies directed at individual behaviors within the family system.

In family therapy, what is meant by a "system"?

Any structured unit based on feedback—such as a family—whose parts interact and influence each other.

What is the basis of family-systems theories?

Understanding how the family operates as a whole in order to understand the behavior of individual members.

How does the family-systems model view a client’s problem behavior?

As the result of intra-familial disturbances rather than solely an intrapsychic mental disorder.

List at least four overarching goals of family therapy.

Improve communication, enhance conflict-resolution skills, reduce stress, increase adaptive functioning, fulfill emotional needs, promote appropriate role relationships, cope with destructive forces, and influence family identity/values.

Why is a comprehensive family assessment important for nurse practitioners (NPs)?

It allows NPs to consider clients within their family system—especially critical when treating children and adolescents.

What three elements make up a complete family assessment?

A basic genogram, assessment of functional/dysfunctional patterns, and an accurate case conceptualization.

What is the main purpose of a genogram in family therapy?

To outline the family’s internal and external structure and assess functioning (ages, occupations, relationships, deaths, divorces, dynamics).

Beyond structure, what does a genogram help assess that can guide psychiatric care?

The genomics of the family (hereditary and relational patterns).

Define family-based treatment.

A broad spectrum of approaches that include formal family therapy sessions as well as supportive groups and other resources.

One family-therapy goal is to enhance what specific emotional outcome?

Each member’s perception that their emotional needs are fulfilled by one another.

Why is understanding family dynamics clinically significant?

Because a client’s symptoms influence—and are influenced by—the family system.

Name two methods used to assess family patterns.

Developing an accurate case conceptualization and conducting competent family-therapy sessions.

On a genogram, what do broken lines between two people indicate?

A conflicted or poor relationship.

How does family therapy differ from the broader concept of family-based treatment?

Family therapy is one component of family-based treatment, which can include education groups, peer support, and other modalities.

Improving conflict-resolution skills in family therapy is expected to yield what outcome?

Reduced stress and increased adaptive functioning.

How does family therapy conceptualize individual behaviors?

As shaped by, and embedded in, the interactional patterns of the family system.

Why are role relationships important topics in family therapy?

They help promote appropriate roles across sexes and generations, preventing confusion and conflict.

What is the National Alliance on Mental Illness (NAMI)?

A national organization that provides education, advocacy, and support for people with mental illness and their families.

What risk arises when NPs omit needed family therapy from a treatment plan?

Treatment can become counterproductive and detrimental to the client’s well-being.

Contrast functional and dysfunctional families on structure and communication.

Functional families have solid structure, clear roles, open communication, and support individuation; dysfunctional families lack these qualities and display more conflict.

Which early theorist treated phobic problems in children, influencing family therapy?

Sigmund Freud.

Which psychologist is credited as the first to practice formal family therapy?

Alfred Adler, through the Child Guidance movement.

What is the typical length and frequency of family-therapy sessions?

8–20 one-hour sessions meeting weekly.

During sessions, family therapists primarily focus on what timeframe?

Here-and-now interactions that maintain symptoms and dysfunction.

Name the four popular approaches to family therapy.

Systemic (Bowen), Structural (Minuchin), Strategic (Haley & Madanes), and Emotionally Focused Therapy (EFT).

Who founded systemic family therapy?

Murray Bowen.

Who developed the genogram?

Murray Bowen.

Who asserted that therapists must work through their own family dysfunction before treating others?

Murray Bowen.

Define "differentiation of self" in Bowenian theory.

The degree to which a person maintains a solid sense of self while remaining emotionally connected to the family; higher differentiation equals less pull into dysfunctional patterns.

List two characteristics of an undifferentiated person.

Little sense of self, high susceptibility to family influence, and greater vulnerability to stress.

What is "fusion" in Bowenian terms?

A blurring of boundaries whereby two undifferentiated people operate as a single emotional unit.

In family systems, what is a "triangle"?

A three-person relationship formed to diffuse tension between two members by drawing in a third.

What is the multigenerational transmission process?

The passing of dysfunctional patterns from one generation to the next, often charted in genograms.

Describe the nuclear-family emotional system.

A process by which partners select each other based on equivalent levels of differentiation, perpetuating certain patterns.

How does the family-projection process operate?

Parents transmit their own undifferentiation and anxiety to children, often targeting the most vulnerable child.

Define "emotional cutoff."

Managing anxiety by severing contact with family members, which can lead to isolation instead of true differentiation.

Overall goal of systemic (Bowenian) family therapy?

Increase family members’ levels of self-differentiation for healthier intergenerational relationships.

Name three common Bowenian interventions.

Promoting "I" statements, de-triangulating family members, and repairing emotional cutoffs.

Who developed Structural Family Therapy?

Salvador Minuchin.

What did Minuchin primarily examine in families?

Rules, coalitions, power structures, communication patterns, and boundaries.

In Minuchin’s model, what are subsystems?

Smaller units within the family (e.g., spousal, parental, sibling) that perform specific functions.

Define "boundaries" in Structural Family Therapy.

Physical or emotional barriers that protect members; should be clear yet flexible.

What characterizes an enmeshed family?

Diffuse boundaries leading to over-dependence and loss of autonomy.

What characterizes a disengaged family?

Rigid boundaries resulting in excessive autonomy and emotional distance.

What is a coalition in structural terms?

A dysfunctional alliance of two members against a third (cross-generational, schismatic, or skewed).

Define parentification.

A role reversal where a child assumes power or responsibilities that belong to the parents, often harmful to development.

Primary goal of Structural Family Therapy?

Create an effective structure with functional subsystems and clear boundaries.

How does a structural therapist initially interact with the family?

By "joining"—affiliating with the family to become a credible agent of change.

What are enactments?

Live enactments of problematic interactions during therapy to reveal structural issues for intervention.

What is structural mapping?

A symbolic diagram of family structure used to highlight boundaries, coalitions, and interaction patterns.

In structural mapping, what does a straight line signify?

A rigid boundary (disengagement).

In structural mapping, what does a dotted line signify?

A diffuse boundary (enmeshment).

In structural mapping, what does a dashed line signify?

A clear, healthy boundary.

What is the main focus of Strategic Family Therapy?

Altering dysfunctional behavior patterns that perpetuate problems through misguided solutions.

Strategic Family Therapy grew from which theoretical concepts?

Feedback loops, double binds, cybernetics, homeostasis, and circular causality (Bateson et al.).

Who were the key 1980s figures in Strategic Family Therapy?

Jay Haley and Cloe Madanes at the Family Institute of Washington, D.C.

Define cybernetics in the context of family therapy.

The theoretical study of control and communication processes in systems.

Define homeostasis for families.

The tendency of a family system to maintain a stable, balanced state.

What are feedback loops?

Circular information pathways where system output is fed back to regulate future behavior.

Explain circular causality.

The concept that family members mutually influence each other in ongoing cycles, not linear cause-effect chains.

Differentiate first-order and second-order change.

First-order: superficial behavioral change without altering system rules; Second-order: fundamental restructuring of the system and its rules.

Primary goal of Strategic Family Therapy?

Use strategic directives (behavioral tasks) to interrupt patterns that maintain dysfunction.

Describe the therapist’s stance in Strategic Therapy.

Empathetic, collaborative, and directive; each member details the problem and failed solutions.

What is a paradoxical technique?

Assigning an intervention that seems illogical or contrary to the goal but disrupts dysfunctional patterns.

Describe the "pretend" technique.

Instructing the symptomatic person to voluntarily exaggerate symptoms, revealing control and reducing dysfunction.

What are "ordeals" in Strategic Therapy?

Requiring clients to perform mildly noxious tasks if they engage in the symptomatic behavior, discouraging it.

Define "rituals" as a strategic intervention.

Structured series of actions that foster belonging and togetherness (e.g., cooking a meal together).

What is an invariant prescription?

A directive (often parents covertly spending time together) designed to break entrenched interactional sequences.

What is Emotionally Focused Family Therapy (EFT)?

A short-term, evidence-based therapy (10–15 sessions) helping families/couples strengthen emotional bonds by exploring moment-to-moment experiences.

Overall goal of EFT?

Expand constricted emotional responses, restructure interactions, and foster accessible, responsive, caring cycles.

During EFT assessment, what tools are commonly used?

No formal tools like genograms; the therapist instead creates a comfortable environment for open emotional dialogue.

List four interventions used in EFT to access core emotions.

Empathetic attunement, reflective statements, evocative questions, and creative images/metaphors (plus acceptance and attachment-building).

Who developed EFT in the mid-1980s?

Leslie Greenberg and Sue Johnson.

On what foundations is EFT built?

Humanistic approaches (Rogers, Gestalt) and attachment theory.

Differentiate primary and secondary emotions.

Primary: fundamental, direct responses to events (e.g., sadness after loss); Secondary: reactions to one’s thoughts/feelings about emotions (e.g., guilt about anger).

Name the four attachment styles cited in EFT.

Secure, Insecure (avoidant), Anxious (preoccupied), and Vacillating (disorganized/trauma-related).

How do negative emotional responses impact relationships?

They undermine repair attempts and perpetuate negative interaction cycles.

Define an attachment injury.

Relational trauma marked by perceived abandonment, betrayal, or violation of trust.

What is empathetic attunement in EFT?

Therapist’s deep emotional connection to clients, validating and mirroring their core affect.

What is the NP’s primary role when considering family therapy?

Collaborate with the family to decide whether therapy should involve individuals, subsystems, or the entire unit.

What two tasks facilitate change after assessment?

1) Contracting with the family; 2) Working collaboratively on the identified problem.

How should diagnoses be communicated in family therapy?

Openly explain diagnoses to the family so everyone can participate in treatment planning.

How does the DSM-5 assist family therapists?

Provides categories for diagnosing relational problems (e.g., parent-child relational problems) to guide treatment.

Why is a family assessment mandatory in child/adolescent psychiatric evaluations?

Understanding family dynamics is essential to interpreting and treating the child’s symptoms effectively.

Why must therapists create a supportive environment?

A safe, supportive space encourages open emotional exploration, critical to successful family therapy.

Who founded Structural Family Therapy and directed the Philadelphia Child Guidance Clinic?

Salvador Minuchin.

Who founded Strategic Family Therapy and the Family Institute in D.C.?

Jay Haley and Cloe Madanes.

Which founders emphasized attachment styles and injuries in EFT?

Leslie Greenberg and Sue Johnson.