Family therapy final

Liberation psychology

is a field of psychology that focuses on understanding the psychological effects of oppression and promoting social justice and liberation for marginalized groups.

Ever-changing, self-reflective theory and practice: social reality as multiple, fluid, and intersectional

Focus on the oppression experienced by poor and marginalized communities

Liberation psychology is based on

Comas-Diaz and Torres Rivera (2020)

Many global precursors to liberation psychology, primarily draw from Martín-Baró (1994)

Western US-based psychology does not address the suffering and violence of many marginalized communities, caters to dominant societies, and fails to engage with the socio-political context of these groups.

Reorientation to psychology

must focus on ways that current institutions marginalize communities with extreme oppression, discrimination, and poverty

Recovering historical memory

reclaiming of “real” history that is told from the marginalized persons’ perspective (versus told from the colonizer’s pov) to acknowledge and validate the experiences, struggles, and contributions of marginalized groups in the historical narrative.

Deideologizing every day experience

in recovering historical memory, through critical questioning persons reconstruct their reality based on the everyday activities (versus the imposed reality)

Denaturalization

rather than normalizing discrimination and oppression, see them as denatural: question the interest of power dynamics that create reality

Problematization

develop an understanding of the problems faced by marginalized communities from within the community. Process of discussing, questioning, creating critical reflection on everyday

Virtues of the people

strength and resilience within oppressed persons experiences across generations

Conscientization

ongoing awakening of critical consciousness in persons that leads to action and what is possible

Power dynamics

challenge and analyze power dynamics in research and practice; wellness, liberation, and oppression are both political and psychological

Praxis

the integration of theory and practice, emphasizing action and reflection in pursuit of social change.

connection between theory and action/practice, how does theory lead to action?

Otherwise theory is of limited use

Bowen’s Intergenerational Family Therapy in a nutshell

a therapeutic approach that explores the influence of family history and dynamics across generations on individual behavior and relationships.

Increasing client’s awareness of how current behavior is connected to multigenerational processes

• Primary tool for client change is the counselor’s level of differentiation

Founders of Bowen’s Intergenerational Family Therapy

Murray Bowen*

(Philip Guerin • Thomas Fogarty • Monica McGoldrick • Betty Carter)

Differentiation

the process by which an individual develops a clear sense of self while maintaining emotional connections with family members. It involves balancing autonomy and intimacy.

Person’s ability to separate intrapersonal and interpersonal distress

• Intrapersonal: separate thoughts from feelings in order to respond rather than react

• Interpersonal: know where oneself ends and another begins without loss of self

• Balance the need of togetherness and autonomy

• Differentiated people are better able to handle ups and downs of intimacy

Overview of Treatment for Bowen’s Family therapy

Process-oriented therapy

• Relies on self-of-the-therapist: counselor’s level of differentiation

• Does not emphasize techniques and interventions

• Uses insight and counseling relationship to increase client’s levels of differentiation

Multigenerational Transmission Process

Emotional processes from prior generations are present and “alive” in current family emotional system

• Children may emerge with higher, equal, or lower levels of differentiation than parents

• Severe emotional problems result in lower level of differentiation with each generation

Assessing Multigenerational Patterns

Use of genogram or oral interview to identify patterns

• Identify how current situation fits with these patterns

• Is client replicating or rebelling against the pattern?

• How has pattern evolved with this generation?

Emotional Triangles

Triangulate: the process in which a dyad draws in a third person to stabilize it

• Basic building block of families

• The third person used to alleviate tension but conflict remains

Family Projection Process

Process in which parents “project” immaturity onto one or more of their children

• Causes decreased differentiation in subsequent generations

• The child who is the focus of parental anxiety will be less differentiated

Emotional Cut-Off

A person no longer emotionally engages with another in order to manage anxiety

• Can take form of no longer seeing /speaking to other person

• Client may believe cut-off is a sign of mental health/superiority

• The more people can stay emotionally engaged without harboring anger, resentment, or fear, the healthier they will be and able to navigate relationships effectively. ____ can lead to unresolved issues and perpetuate patterns of dysfunction in the family.

Sibling Position: Typical Roles

Older Children: Responsibility and authority

• Later-born Children: Underdog and question status quo

• Youngest Child: Avoids responsibility in favor of freedom

• Cultural background significantly shapes roles

Societal Regression

Societies experiencing sustained chronic anxiety, respond with emotionally based reactive decisions

• Regress to lower levels of functioning

• Vicious cycle of increased problems and symptoms

• Cycles in which levels of differentiation rise and fall

Role of the Counselor in Bowens intergenerational FT

Differentiation: Emotional Being of the counselor

• Level of differentiation and emotional being central to change process

• Believe clients can only differentiate as much as counselor has differentiated

• A Non-anxious Presence

• Emotionally engaged stance that is nonreactive

• Counselor doesn’t react to attacks without careful reflection

• Role of expert

• Objective researcher: help family to assess and understand relational styles

• Use questions to help gain insight

Interventions Bowens intergenerational FT

• Primary “technique” is counselor’s ability to embody the theory

• Process questions

• Encouraging differentiation of self

• Genograms

• Detriangulation

• Relational experiments

• Going home again

• Relationship experiments

• I-positions

Structural Family Therapy

A therapeutic approach focusing on family dynamics and structures, aiming to improve relationships by modifying interactions, boundaries, and hierarchies within the family system. It emphasizes organizing family structure to promote healthier functioning.

Significant Contributors Structural FT

• Salvador Minuchin

• Harry Aponte

• Marion Lindblad-Goldberg

Boundaries

• Rules for managing physical/psychological distance in family members

• Define regulation of closeness, distance, hierarchy, and family roles

• Are organic, living processes

• Are culturally defined

Types of Boundaries

• Clear or “normal” boundaries: Close emotional contact while allowing each person a sense of identity

• Enmeshment and diffuse boundaries: Strong sense of mutuality/connection at expense of individual autonomy

• Disengagement and rigid boundaries: Lead to relational disengagement; autonomy emphasized at expense of emotional connection

Enactments

• Counselor prompts family to re-enact a conflict or other interaction

• Used to assess and alter problematic interactions: map, track, and modify the family structure through direct observation in therapy sessions.

Used for spontaneous enactment of problem or to target reported problem interactions

• Key intervention used to restructure family interactions

Treatment Process of Structural FT

Main phases:

1. Build an alliance: Join family, accommodate to their style

2. Evaluate/assess: Map family structure, boundaries, hierarchies

3. Address problems identified in assessment: Intervene to transform structure to diminish symptoms

Who attends therapy in Structural FT

• Entire family preferably

• Subsystems

• Counselor may meet with specific subsystems or individuals to achieve structural goals

Therapist Role in Structural FT

• Joining and accommodating: counselor “joins” the family system and accommodates to its style

• Therapeutic spontaneity: flow naturally and authentically

• Therapist’s use of self: use self to relate to family, varying from being highly involved to more detached

• “Make it happen:” do whatever it takes to make change happen; who’s the expert in the room?

• A softer style: Minuchin moved from being active challenger to using humor, acceptance, support, and suggestion

Structural FT Assessment Elements

• Role of the symptom in the family

• Subsystems: couple, parental, sibling, gender, interests, etc.

• Cross-generational coalitions: particularly negative, subsystem between parent and child against other parent

• Boundaries

• Hierarchy: effective, insufficient, excessive

• Complementarity

• Family development/cycle

• Strengths

Goals for All Families in Structural FT

• Clear boundaries between all subsystems

• Clear distinction between marital/couple subsystem and parental subsystem

• Effective parental hierarchy and severing of cross-generational coalitions

• Family structure that promotes development/growth of individuals and family

Systemic reframing

• Highlights complementary relationships in family

• Piece together members’ description of problem and reframing to reveal broader systemic dynamic

Boundary Making

• Actively setting boundaries to interrupt habitual (too close or too rigid) interaction patterns

Family’s worldview

• Challenging unproductive assumptions by questioning assumptions in family system

Intensity

• Different levels and styles of intensity used

• Turns up emotional heat using tone of voice, pacing, and word choice

Crisis induction

• Used with families who chronically avoid a problem

Unbalancing

• Used for extreme difficulties in hierarchy or when (IP) is being “scapegoated”

• Use expert position to temporarily “join sides” with scapegoated individuals or subsystems that need stronger boundaries

• Done only briefly with specific realignment goals in mind

  • Only after more direct interventions, such as enactments and challenging assumptions, have failed

Expanding family worldview

• When possible, the therapist works with family beliefs to expand functioning

Compliments

• Used to bolster behaviors that support families in moving toward goals

Shaping competence

• Noticing small successes along the way to reach goals

Cognitive-behavioral family therapy

• A therapeutic approach that focuses on modifying negative thought patterns and behaviors within the family context to improve communication and relationships.

• Examines how family members reinforce each other’s behaviors, symptoms, and relational patterns

• Main focus on Parental Training

• Counselor takes a directive/expert role

Cognitive-behavioral family therapy in a nutshell

• Roots in behaviorism; its premises are still widely used with phobias, anxiety, and parenting

• Family CBTs (CBFT) attempt to integrate systemic concepts into standard cognitive-behavioral techniques

• Examining how family members reinforce one another’s behaviors to maintain symptoms and relational patterns

• Counselors assume directive, “teaching” relationship

Significant Contributors Cognitive-behavioral FT

• Gerald Patterson and Marion Forgatch

• Neil Jacobson and Andrew Christensen

• Norman Epstein

• John Gottman

• Frank Dattilio

Parent Training

• Focus on:

• Reinforcement: positive or negative responses from environment shape future behavior

• Consistency: reinforcing every time is the key, especially in the beginning

• Teaching compliance and socialization

• Improving parental requests

• Monitoring and tracking

• Creating a contingent environment

• Five-minute work chore

Frequency of Reinforcement and Punishment

• Immediacy: the more immediate the reinforcement or punishment, the quicker the learning

• Consistency: the more consistent the reinforcement or punishment, the quicker the learning

• Intermittent Reinforcement: random positive reinforcement of well-established desired behaviors helps sustain them

Process for CBFTs

4 Steps

• Assessment

• Target behaviors and thoughts for change

• Educate

• Replace and retrain

The Therapeutic Relationship

• Directive Educator and Expert: directs and educates on how to better manage problems

• Contemporary use of empathy in CBT: used to build rapport

• Written Contracts: spell out goals and expectations to help structure the relationship and to increase clients’ motivation

Case Conceptualization and Assessment for CBFT

Defining Problems

• Assessment of baseline functioning

• Functional analysis and mutually reinforcing behaviors

• A-B-C theory

• Examine family schemas and core beliefs

Goal Setting: General Goals CBFT

• Behavioral and Measurable

• Agreeable: use authoritative role to identify goals that are agreeable to all

• Commitment: obtain explicit commitment from family to complete out-of-therapy assignments, often a written contract

Classical Conditioning

• The procedure is described as conditioned and unconditioned stimuli and responses

How it works:

The natural process

• Food (unconditioned stimulus; UCS) →Salivation (unconditioned response; UCR)

Process of pairing conditional stimulus with response

• Food (UCS) + Bell (conditioned stimulus; CS) → Salivation (conditioned response: CR)

Resulting pairing

• Bell (CS) →Salivation (CR)

Forms of Reinforcement and Punishment

• Positive reinforcement or reward

• Rewards desired behaviors by adding something desirable (e.g., a treat)

• Negative reinforcement

• Rewards desired behaviors by removing something undesirable (e.g., relaxing curfew)

• Positive punishment

• Reduces undesirable behavior by adding something undesirable (e.g., assigning extra chores)

• Negative punishment

• Reduces undesirable behavior by removing something desirable (e.g., grounding)

Mindfulness in a nutshell

• Mindfulness: intentional focus on present moment experience without judgment

• Acceptance: accepting difficult thoughts and emotions in order to transform them

• Compassion: encourage clients to curiously and compassionately observe difficult thoughts and feelings without the intention to change them

• Shift Relationship to Problem: by changing how clients relate to problems, they experience new thoughts, emotions, and behaviors in relation to the problem

• Buddhism: associated with Buddhist forms of meditation

• Most world religions have some form of mindfulness (e.g., centering prayer for Christian/Catholic)

Mindfulness

• Observe Present Moment Experience

• Involves observing a single focus (the breath, sensation, etc.) in the present moment while quieting the mind’s inner chatter

• Compassionately Welcome All Experience

• When thoughts or sensations arise, avoid judging as good or bad, preferred or not preferred

• Avoid judging self when mind wanders

• Observer Position

• Develops ability to experience mind in action from the position of an observer

• Allows for greater conscious choice, reduces emotional reactivity

Mindfulness-Based Therapies

Change the way client’s relate or view their problem; encourage acceptance

Narrative Family Therapy

A therapeutic approach that focuses on the stories individuals and families tell about their lives, aiming to reshape these narratives to foster healthier relationships and behaviors. It encourages clients to view their challenges as separate from themselves, promoting empowerment and agency in rewriting their narratives.

Postmodernism

A philosophical approach that questions objective truths, emphasizes the subjective nature of reality, and stresses the importance of cultural and social contexts in shaping human experiences and knowledge.

• questions the existence of a singular, universal truth to explain human beings and the systems in which they live

• believes in multiple subjective realities that cannot exist independently of the observer

• reality is based on the use of language

• truth & reality are bound by history and context

Social constructionism

emphasize the ways in which people make meaning in social relationships

• Consideration of multiple realities

• Our modes of explanation are derived from social relationships

• more popular explanations enjoy consensual validation and other explanations relegated to lesser positions

• All explanations are social: to make sense is to make sense to somebody in some way that invites a shared view

• Our descriptions of self and the world create our future

• Since use of language creates our future, it is vital that we reflect upon it for our own well-being

Significant contributor Narrative Therapy

Michael White and David Epston in Australia and New Zealand

Narrative Family Therapy in a nutshell

• Narrative FT based on the premise that we “story” and create meaning of life events using available dominant discourses

• People experience “problems” when personal life does not fit with these dominant societal discourses and expectations

• Process involves separating the person from the problem

• Clients identify alternative ways to view, act, and interact in daily life

Dominant Discourses

• Culturally generated stories about how life should go

• Used to coordinate social behavior: how married people should act, what happiness looks like, how to be successful, etc.

Local Discourses

• Occur in our heads, closer relationships, and marginalized communities

• Have different “goods” and “shoulds” than dominant discourses

• Counselors help clients become aware of how different discourses are impacting their lives

Treatment Phases in Narrative Therapy

• Meeting the person apart from the problem

• Listening for effects of the dominant discourses

• Separating persons from problems: externalizing

• Enacting preferred narratives: Identifying new ways to relate to problems

• Solidifying: Strengthening preferred stories and identities in communities of support

Therapeutic Relationship in Narrative FT

• Meet Person Apart from Problem

• Ask about client’s hobbies, daily activities, etc.

• “The problem is the problem. The person is not the problem.”

• Optimism and Hope

• Unwavering hope

• Co-author and Co-editor

• Counselor and client engage in a joint process of constructing meaning

• Counselor does not rewrite client story

• Investigative Reporter

• Intense curiosity

• Wanting to know all the details of the story

Case Conceptualization narrative FT

• Problem-Saturated Stories

• Story in which the “problem” plays leading role and client plays a secondary role, generally that of victim

• Unexpected Outcomes/Sparkling Events

• stories or subplots in which the problem-saturated story does not play out in its typical way

• Dominant Cultural and Gender Discourses

• Discourses that most directly inform the perception of a problem

• Local and Alternative Discourses

• Discourses that do not conform to dominant discourse

Goal Setting Narrative FT

• Overarching Goal

• Enact preferred realities and identities

• Increasing clients’ sense of agency

• Early-Phase Goals

• Externalize

• Middle-Phase Goals

• Target immediate symptoms and presenting problem

• Late-Phase Goals

• Target personal, relational, and expanded community identities

Externalizing

involves separating the person from the problem, allowing clients to view issues as external entities rather than intrinsic to their identity.

Feminism and Family Therapy

emphasizing gender equity, power dynamics, and the impact of societal norms on family relationships.

significant contributors to feminists therapy

• Rachel Hare-Mustin (1978):

  • First feminist family therapist to critique and challenge family therapy’s assumptions and practice

  • called for a total revision of family therapy that made gender issues central to assessment and practice

• Monica McGoldrick, Carol Anderson, and Froma Walsh:

  • Prominent women in family therapy:

• The Women’s Project (1988; Marianne Walters, Betty Carter, Peggy Papp, and Olga Silverstein)

  • challenged the value of neutrality in family therapy and gender roles, distribution of power and finance in “normal” family life

Commonalities amongst Feminists:

• belief that patriarchy is alive and sick in sociopolitical life and the life of families

• “the normal family” has too often been defined as one with heterosexual parents

  • has not been so “normal” for mothers, reflects discrimination against women

• willingness to analyze power and challenge power differentials in relationships, therapy, and society

• commitment to reform families and society in ways that empower and enfranchise women economically, socially, and politically

• therapeutic processes that include a positive attitude toward women, social analysis, explicit consideration of gender issues for all genders, and treating the personal as political

Key Concepts in feminists therapy

• Honor the experiences and perceptions of women

• The personal is political

• Social transformation and advocacy

• Reject and take a stand against patriarchy:

  • one of the oldest and most universal dominant cultural positions in the world

  • designed to maintain itself and to advance views that benefit the powerful and the privileged

  • also disenfranchises all “other” views, including women’s ways of knowing and being in the world

  • most of the founding family therapy models often established heterosexual, dual-parent families as “the norm” and defined for women “good mothering and femininity”

Therapy Goals in Feminist therapy

• Centralize an analysis of sex-role socialization within the family

• Identify internalized sex-role messages and beliefs

• Challenge and replace sex-role stereotypes and scripts with more self-enhancing belief and stories

• Ultimate goal is to promote and establish egalitarian relationships: respect, caring, nurturing, the exercise of choice, and flexibility

• Meet families at whatever form and at whatever stage they are in

• Allow and contextualize the expression of feelings from fear and anger to pride and celebration

• Help members of the dominant culture look at themselves, challenge their perspectives, find ways to become supportive

• Help family members engage in political or social activism as needed and appropriate

Therapist’s Role in feminist therapy

• Egalitarian relationships

• De-pathologizing women’s lives and experiences

• Valuing the experiences, perspectives, and process of women, including:

  • Empathy

  • Nurturance

  • Cooperation

  • Intuition

  • Interdependence

  • care-giving

  • Assertiveness

  • Relational orientations

Techniques feminists therapy

• Egalitarian relationships

• Consciousness raising

• Gender-role and power analyses

• Self-disclosure

• Bibliotherapy

• Assertiveness training

• Reframing and re-labeling