Family Therapy Notes

Single-Parent Families

  • Defined as households headed by a single parent responsible for their own and their child/children's care.

  • Created by divorce, death, abandonment, unwed pregnancy, imprisonment, adoption, or uncontrollable circumstances (e.g., military assignment).

Statistics

  • Over half a million children are born to unpartnered parents each year.

  • The percentage of single-parent households created by births to unpartnered parents now exceeds those created by divorce.

  • In 2016, approximately 12 million single parents lived with children, comprising 30% of households with children.

  • About 10 million were single mothers, and 2 million were single fathers.

Types of Single-Parent Families

  • a) Divorce

  • b) Death

  • c) Choice

  • d) Temporary Circumstances

a) Single Parenthood as a Result of Divorce

  • Approximately 1 million divorces occur each year in the U.S.

  • 1 in 5 adults has been divorced.

  • Primary issues include financial strain, emotional distress, violence, and substance abuse.

Issues Following Divorce

  • Resolution of the loss of marriage.

  • Acceptance of new roles and responsibilities.

  • Renegotiation of relationships with family and friends.

  • Establishing a satisfactory arrangement with the former spouse.

  • Potential economic strain.

b) Single Parenthood as a Result of Death

Major Tasks:

  • Reestablishment of the surviving parent’s life.

  • Restructuring of the Family (Pulleyblank, 1996).

Family Development Stages:

  • Mourning stage.

  • Readjustment stage.

  • Renewal and accomplishment stage.

c) Single Parenthood by Choice (Intention)

  • Purposefully conceiving a child out of wedlock.

  • Deciding to carry a child to term after an accidental pregnancy.

  • Adopting a child as a single adult.

  • Custodial parent and the mother-father interactive system have time to prepare before the child arrives

  • Usually not be other support outside of the parent’s resources

d) Single Parenthood as a Result of Temporary Circumstances

  • Military deployment.

  • Job change.

  • Typically lasts from a few weeks to several years.

  • May create stress due to its suddenness and seriousness.

Strengths of Single-Parent Families

  • Tend to be more democratic than most family types.

  • Flexibility in roles and rules.

  • Pace at which members go through developmental stages

  • Creativity in locating and utilizing needed materials for their overall well-being

Challenges of Single-Parent Families

  • Defining or refining boundaries and roles alienation.

  • Achieving educational success.

  • Establishing a clear and strong identity and relating to others of the opposite gender.

  • Poverty.

  • Expression of feelings, avoiding emotional hooks to the past.

Approaches for Working with Single-Parent Families

1, Prevention Approaches:

  • Work on couple relationship.

  • Premarital counseling.

  • Programs that help spouses after traumatic separation.

2. Educational and Behavioral Approaches:

  • Helping families communicate clearly.

  • Linking family members to needed support systems (e.g., Parents Without Partners).

  • Assisting them in resolving financial matters.

  • Providing reading or video resources (bibliotherapy).

Role of the Therapist

  • Deal with boundaries, hierarchies, and engagement or detachment.

  • Lay aside personal prejudices and biases.

  • Deal with emotional volatility.

  • Help clients distinguish between emotional and legal aspects of divorce.

  • Help members tap into their inner resources and use support groups.

Process and Outcome

Four Improvements through successful family therapy:

  • Increase confidence and competence in themselves.

  • Develop clear and functional boundaries.

  • Make informed decisions regarding remarriage.

  • Tap into community resources more effectively as well as make use of their own resources

Psychodynamic Family Theory & Bowen Family Theory

A. Premises of the Theory

  • Based on the classic work of Sigmund Freud

  • Resolving conflict occurs through two actions:

    • Strengthening defenses against conflicted wish

    • Relaxing defenses to permit some gratification

  • Understanding one’s unconscious by taking into account context

A.1 Original Concepts

  • Basis of unconscious drives were sexual and aggressive

  • Clients labored under intrapsychic conflicts stemming from childhood, having to do with whether they could express their impulses.

  • Anxiety, expectation of punishment

  • Depression, calamity has already happened

  • Family was the source of the problem but did not sustain it in the present. Relationship with analyst was sufficient to reawaken all of the conflict associated with the original parents. The focus was the resolution of transference.

A.2 Object Relations Theory (1 of 2)

  • Bridge between classical Freudian theory and family therapy

  • Relationship between two people that includes deep emotional attachments.

  • Can exist in the outer world or in the unconscious, inner world

  • Early internal object

  • Can affect how we perceive and relate to others (mental representation of significant others)

Object Relations Theory (2 of 2)

Splitting

  • Unconscious procedure in which object representations are perceived as all good or all bad

  • Lead to difficulties in maintaining balance view

  • Provides a way for psychodynamic clinicians to explain reasons for marital choices and family interaction patterns

  • Stresses the value of working with the unconscious and emotional interactions

Goals of Therapy

  • To free family members from the power of unconscious constraints so they can relate in a healthy way.

  • Separation-individuation or differentiation (similar to Bowen’s concept)

  • To let go of one another in a way that frees the other to become more independent

Conditions for Change

  • Insight is necessary but not sufficient

  • Insights have to be “worked through” to the point where new ways of interacting emerge.

  • The therapist has to interrupt to get couples to get in touch with what they are feeling and avoiding (similar to Bowen’s process questions).

Treatment Techniques

  • Transference

  • Underlying Issues

  • Dream and Daydream Analysis

  • Confrontation

  • Focusing on Strengths

  • Life History

  • Complementarity

  • Interpretation

Transference

  • The projection of feelings, attitudes, or desires onto a significant other such as a therapist (Levy & Scala, 2012)

  • Employed in individual analysis to help clients work through their feelings by viewing the therapist as a significant other with whom relationships are unresolved (Ellis, 2000)

  • Utilized in family therapy to understand dominant feelings within a family unit and delineate what emotions are being directed toward which people

Underlying Issues

  • Underlying individual issues need to be addressed to help couples escape their pathological dance.

  • These issues revolve around basic human concerns, such as the following:

  • Hopes for love, appreciation, and understanding

  • Fears and experiences of disapproval, abandonment, domination, incompetence, and other forms of emotional distress (Nielsen, 2017, p. 2)

Dream and Daydream Analysis

  • The objective is to analyze what needs within the family are not being met

  • May be quite useful for some families in helping them see areas that need attention

  • Can be problematic and difficult to handle if the number of family members participating is large

Divergent Subject Experiences

  • “Person-specific meanings of events that evoke conflict between partners” (Nielsen, 2017, p. 3)

  • Often these meanings are incompletely known to the people themselves or are assumed to be universal

  • People label what is happening in their environments according to their backgrounds, much of which is out of their conscious awareness.

  • Method of gaining insight into each family member's unique perspectives, feelings, and thoughts about themselves, others, and their interactions.

Projective Identification

  • “A form of interpersonal defense whereby people recruit others to help them tolerate their own painful intrapsychic states of mind” (Nielsen, 2017, p. 8)

  • Interpersonalized identification:

    • Starts as an intrapersonal conflict (e.g., “I want to buy a new car, but I should save my money”)

    • It is played out interpersonally (e.g., “I want a new car, but my wife thinks we should save our money”)

  • Externalization of a disturbing self-evaluation (e.g., “I worry I’m too needy” turns to “He won’t give me what I deserve!”

Confrontation

  • The therapist points out to families how their behaviors contradict or conflict with their expressed wishes (Ackerman, 1966).

  • The idea behind confrontation is to help family members become more aware of what they are doing and to change their strategies for coping and becoming functional.

Focusing on Strengths

  • Psychodynamic therapists can help family members change the focus from familial weaknesses to family strengths by emphasizing strengths.

  • Structured activities can be designed to promote cooperation and break dysfunctional patterns of behaving by focusing on strengths.

Life History

  • By taking and assessing a family’s life history, psychodynamic family therapists can report present and past patterns of interactions within the family

  • This process affirms to family members that they are valued and accepted regardless of their backgrounds

  • Taking a family life history promotes trust in the therapist and provides the family members with insight

Complementarity

  • Complementarity is the degree of harmony in the meshing of family roles.

  • A task of the therapist is to help family members provide and receive satisfaction from their relationships.

  • This may mean asking members what they want and what they are willing to do in return.

Interpretation

  • Involves bringing unconscious conflicts between family members into consciousness (Broderick & Weston, 2009)

  • Takes the covert nature out of the discord and allows family therapy to progress in a more straightforward way by increasing the insight of family members into how the past is continuing to affect the present

  • Family members can use this insight to solve its present conflicts effectively without being weighed down by the past

Role of the Therapist

  • Teacher – Therapists help family members understand the influences in their past, especially unconscious ones, that have an impact on them now.

  • Good Enough Mother (Good Enough Parent) – therapist many nurture the family member(s) by providing encouraging behaviors that were absent at earlier developmental stages

  • Catalyst – moves into the “living space” of the family and stirs of interactions

Process and Outcome

Process

  • Free family members of unconscious restrictions

  • Help family members interact with one another as a whole, on the basis of current realities rather than past, unconscious images

Outcomes

  • Differentiation of self

  • Balance their rational cognitive and emotional selves and separate themselves from others in a nonanxious way

  • Crisis resolution – symptom reduction

Defense Mechanisms

  • Repression

  • Denial

  • Regression

  • Projection

  • Rationalization

  • Reaction Formation

  • Displacement

Comparison with Other Theories

  • Linearity - focusing on cause-and-effect interactions

  • Expense and time commitments

  • Intellectual ability

  • Empirical research

Strategic Family Therapy

Strategic Family Therapies

  • Strategic Family Therapies are method oriented and brief in duration.

  • Three distinct branches of strategic family therapy

    • The strategic family therapists of the mental research institute (MRI)

    • The strategic family therapists of the Family Therapy Institute (Jay Haley)

    • The strategic family therapists of the Milan Institute (systemic family therapy/long brief therapy)

Strategic Family Therapy: Influence of Milton Erickson

  • Influenced by the work of Milton Erickson (Hypnosis and Unconscious)

  • The term, strategic therapy, was coined by Jay Haley to describe the work of Milton Erickson

  • Milton Erickson

    • Especially attuned to the power of the unconscious mind as a creative, often positive, solution-generating entity

    • Paid particular attention to details of the symptoms his clients presented

Premises of the Theory

  • Follows many of Milton Erickson’s principles

  • Emphasize short-term treatment of about 10 sessions

  • Brief therapy

  • “No one evaluates which solutions have so far been attempted for the patient’s problems” (Priebe & Pommerien, 1992, p. 433)

  • Planned, Problem-focused, Practical (3P)

  • Aimed at disrupting the problem-maintaining behaviors or encouraging new behaviors.

Premises of the Theory

  • Understanding how patterns of communication and behaviour contribute to maintaining the problem.

  • This approach pays close attention to communication patterns, hierarchies, and power dynamics within the family to create change.

  • Concentrates on seven dimensions

7 Dimensions of Strategic Family Therapy

  • Family rules: overt and covert rules families use to govern themselves

  • Family homeostasis: tendency of the family to remain in its pattern of functioning unless challenged to do otherwise (e.g.: bedtime)

  • Quid pro quo: responsiveness of family members to treating others in the way they are treated

  • Redundancy principle: fact that a family interacts within a limited range of repetitive behavioral sequences

7 Dimensions of Strategic Family Therapy

  • Punctuation: idea that people in a transaction believe that what they say is caused by what others say

  • Symmetrical relationships and complementary relationships: fact that relationships within a family are both among equals (symmetrical) and among unequal's (complementary)

  • Circular causality: idea that one event does not cause another, but that events are interconnected and that the factors behind a behavior are multiple (e.g.: kiss/slap)

Treatment Techniques (1 of 3)

  • Reframing: involves giving a different interpretation to induce a cognitive shift within family members and alter the perception of a situation

  • Directive: instruction from a therapist for a family to behave differently

    • Nonverbal messages (e.g., silence, posture)

    • Direct and indirect suggestions (e.g., “Go fast/You may not want to change too quickly”)

    • Assigned behaviors (e.g., “When you think you won’t sleep, force yourself to stay up all night”)

Treatment Techniques (2 of 3)

  • Paradox (similar to prescribing the symptom) – gives client families permission to do something they are already doing and is intended to lower or eliminate resistance

  • Restraining: telling family they are incapable of doing anything other than what they are currently doing (“I am not sure you can do anything other than what you are doing now.”)

  • Prescribing: instructing families to enact a troublesome dysfunctional behavior in front of the therapist (E.g.: Video game playing)

  • Redefining: attributing positive connotations to symptomatic or troublesome actions

Treatment Techniques (3 of 3)

  • Ordeals: involves helping the client to give up symptoms that are more troublesome to maintain than they are worth (indirect constructive behaviours)

  • Pretend: involves asking family members to pretend to engage in a troublesome behavior, such as having a fight (experiencing control of previous involuntary action)

  • Positioning: acceptance and exaggeration of what family members are saying, to see the absurdity (father-son relationship)

Role of the Therapist

  • First task: Define a presenting problem so that it can be worked on and solved

  • Most are overtly active and directive

  • Use presenting problems as a way to bring about change in families by giving the tasks (communication/problem solving) that are usually carried out between sessions.

Process and Outcome

  • Goal: Resolve, remove, or ameliorate the problem on which the family agreed to work

  • Four common procedures for ensuring a successful outcome:

    • Define a problem clearly and concisely

    • Investigate all solutions previously tried

    • Define a clear and concrete change to be achieved

    • Formulate and implement a strategy for change (Watzlawick,1978)

  • Focus of changing vicious cycles to virtuous ones

Solution-Focused Family Therapy

Solution Focused Brief Therapy

  • Grew out of strategic therapy

  • Represents a departure from a focus on pathology-drive approaches to therapy by concentrating on skills, strengths, and resources that clients possess

  • It is change-oriented in that it emphasizes finding solutions for dealing with problems

Premises of the Theory

  • Built on the philosophy of social constructionism

  • Shares some of the same premises about families as the M R I strategic approaches

  • Emphasizes the belief that dysfunctional families get stuck in dealing with problems

  • Aim of therapy is to break repetitive, nonproductive behavioral patterns by setting up situation in which families take a more positive view of troublesome situations and participate actively in doing something different

Premises of the Theory

  • Identifying what a problem is versus a nonproblem (or exception) is a key component in solution-focused brief therapy

  • Three basic rules for helping families make positive changes:

    • If it is not broken, do not fix it.

    • Once you know what works, do more of it.

    • If something does not work, do not do it again. Do something different.

Premises of the Theory

  • Does not focus on a detailed family history of problems

  • Causal understanding is unnecessary.

  • Families really want to change.

  • Only a small amount of change is necessary.

Treatment Techniques

  • Co-creation of a problem.

  • Exceptions

  • Second-order (qualitative) change

  • Compliment

  • Clue

  • Skeleton keys

Example of Skeleton Keys

  • Between now and next time we meet

  • Do something different

  • Pay attention to what you do when

  • A lot of people in your situation would have

  • Write, read, and burn your thoughts

Questioning Techniques

Exception Questions

  • Tell me about times when you don’t get angry.

Coping Question

  • How have you managed so far?

Open-ended question

  • Build rapport

  • Explore and establish

Questioning Techniques

Miracle Question

  • Invites family members to suspend their present frames of reference and enter a reality they wish to achieve

Scaling Question

  • Scale of 1 (low) to 10 (high) to help clients in examining and moving toward their goals.

Presuppositional Question

  • This question aimed to influence clients’ perceptions to the directions of solutions and help clients gain insight regarding the causes in a family therapy session. Family members are led to believe that a solution will be achieved.

  • Help clients recall and discuss information about their strengths, abilities, and successes.

Role of the Therapist

  • Therapists determine how active a family will be in the change process. Clients usually fall into one of three categories

    • Visitors

    • Complainants

    • Customers

  • Therapists are facilitators of change

  • Presuppositional questioning

  • Positive blame

Role of the Therapist

  • Solution-focused family therapists believe that it is important to fit therapeutic interventions into the context of family behavior

  • Often a team approach

  • Solution-focused family therapists encourage families to make small changes and to do so rapidly

  • Therapist does not distinguish between short- and long-term problems

Process and Outcome

  • Solution-Focused Family Therapy is focused on encouraging client-families to seek solutions and utilize internal resources.

  • Pathology does not play a role in the process.

  • Assumes that change is inevitable – it’s only a matter of when.

Unique Aspects of Solution-Focused Family Therapy

  • Solution-focused theories concentrate on and are directed by a family’s theory

  • Therapists assist families in defining their situations clearly, precisely, and with possibilities

  • Solution-focused therapy does not focus on clinical understanding of the family situation by the family or the therapist. The focus is on change.

  • It is empowering and meant to assist families in assessing and utilizing their resources

  • Emphasizes achievable goals, such as small behavioral changes.