Family Models:

structural model,
a model of family therapy that views the family as an open system and identifies subsystems within the family that carry out specific family functions. When faced with demands for change, individual family members, family subsystems, or the family as a whole may respond with growth behaviors or maladaptive behaviors. The goal of family therapy is to help family members learn new scripts or transactional patterns.

Functional model Interactional model Developmental model

FAMILY DEVELOPMENTAL THEORY

(Taken from Scott Plunkett's FES 432 Course Pack)

HISTORICAL DEVELOPMENT Family developmental theory is an approach to studying families, which is useful in explaining patterned change, the dynamic nature of the family, and how change occurs in the family life cycle. The roots of family developmental theory date back to the 1930s from works of sociologists, economists, and demographers who established family categories (which were the precursors to the stages of development From the mid 1940s to the early 1950s, theorists such as Paul Glick, Evelyn Duvall, Reuben Hill, and Rachel Ann Edwards contributed to a more sophisticated developmental approach. Since the 1950s, family developmental theory has been used to explain the processes observed in families over time.

FAMILY DEVELOPMENTAL THEORY EVOLVED IN THREE PHASES Phase I Theorists Focused on The Family Life Cycle Process of birth, growth, maintenance, shrinkage and death Phase II - contemporary theory Theorists Focused on Roles and within the family Relationships

Family is composed of social roles and relationships that change with each stage of the family

Phase III Theorists critique the theory Look at the limitations and strengths of the framework. One criticism is that the framework is biassed towards intact nuclear families, only one of many different types of family structures

MAJOR CONSTRUCTS

Family developmental theory includes two basic concepts 1. the life cycle The family life cycle divides the family experiences into stages over the life span and describes changes in family structure and roles during each stage. 2. developmental task. Developmental tasks are the growth responsibilities that arise at certain stages in the life of the family.

To be successful, family members need to adapt to changing needs and demands and to attend to tasks that are necessary to ensure family survival.

Definitions Family life cycle Set of predictable steps or patterns and developmental tasks families experience over time. o The family life cycle concept facilitates studying the family from beginning to end. Family stage A time period in the life of a family that has a unique structure. o FOR EXAMPLE CONSIDER DUVALLS STAGES OF THE FAMILY LIFE CYCLE, FAMILIES WITH PRESCHOOL CHILDREN Transition The shift from one family stage to another o Consider the Intact Family Life Cycle. The transition, for example,

from Families with Adolescence to Launching Children is what occurs in the family as all members make the adjustment.

ASSUMPTIONS Not age that matters, but the stage in family development Individual Development is important, but development of group of interacting individuals is most important Developmental processes are inevitable and important in understanding families o o Growth from one stage to another is going to happen. Families and individuals change over a period of time. They progress through a series of similar developmental stages and face similar transition points and developmental tasks. To understand the family we must consider the challenges they face in each stage, how well they resolve them, but how well they transition to the next stage. The success or difficulty of achieving the developmental tasks in each stage leads to readiness for the next stage or difficulty in later stages. The family is dynamic and we analyze how well they master tasks at each stage of development.

STRENGTHS The ability to view the dynamic nature of the family over long periods of time The ease of understanding the stages and developmental tasks and the challenges families have to face

CRITICISMS Lack of ability to account for different family forms, and gender, ethnic and cultural differences. It isnt culturally relavent or sensitive to other life style choices STAGES OF THE FAMILY LIFE CYCLE (ACCORDING TO EVELYN DUVALL)

Stage 1: Married couples o (without children)

Stage 2: Childbearing families o (oldest child, birth-30 months)

Stage 3: Families with pre-school children o (oldest child, 2 1/2-6years) Stage 4: Families with schoolchildren o (oldest child, 6-13 years) Stage 5: Families with teenagers o (oldest child, 13-20 years)

Stage 6: Families as launching centers o (first child gone to last child leaving home) o Stage 7: Middle-age parents o (empty nest to retirement) Stage 8: Aging family members (retirement to death of both spouses)

Assessment of Family Functioning

Multisystemic conceptualizations of effective family functioning are guided by social-ecological and family systems theories and by research on child development, developmental psychopathology, parenting practices, marital relations, and individual parent and child characteristics associated with positive and negative outcomes for youth. Effective Family Functioning The Family as a System The MST perspective on effective family functioning embodies systems theories and the assumptions of multicausality and reciprocity of interactions that characterize these theories. Thus, the behavioral and psychological functioning of all family members is understood in terms of ongoing and repetitive patterns of family transactions rather than in terms of unidirectional and linear interpersonal or intrapsychic processes. Family problems are seen as both affecting and being affected by how the family interacts as a whole. Consistent with pragmatic (i.e., focused on changing behavior in the present) as

versus esthetic models of the family and family therapy (see Alexander, HoltzworthMunroe, & Jameson, 1994; Henggeler, Borduin, & Mann, 1993), MST family interventions aim to change the everyday patterns of interaction thought to sustain the identified problems. The present-focused and solution-oriented nature of MST is particularly consonant with structural (S. Minuchin, 1974) and strategic (Haley, 1976) models of family therapy. Structural family therapy The structural model conceptualizes the family in terms of marital, parental, and sibling subsystems that are constructed along generational and role lines. Each subsystem has boundaries such that all family members do not have equal access to the subsystem. Boundaries should be flexible, however, to facilitate the capacity of the family system to respond to the needs of individual family members or to environmental demands. The structural model views child emotional and behavioral problems as signs that subsystem boundaries are too weak or too strong. Terms such as enmeshment and disengagement describe family interaction patterns in which boundaries are excessively porous or rigid. Porous boundaries, for example, can fail to promote the emancipation and independent achievements of children; rigid boundaries can limit the family's capacity to respond to environmental stress and meet the affective needs of family members. Constructs such as triangulation and parent-child coalition describe transactional patterns that confuse parent-child and spousal boundaries, often in ways that involve the child in the negotiation of adult subsystem conflict. Treatment-related changes in these patterns are associated with improvements in the antisocial behavior of adolescents (Mann, Borduin, Henggeler, & Blaske, 1990).

Strategic family therapy Strategic formulations also inform the MST clinician's assessment of family functioning. To design interventions that effectively address interactions within and between systems (Principle 5), the MST practitioner undertakes assessment of the "recursive sequences of behavior" (Haley, 1976) associated with an identified problem. The strategic family therapy tenet that emotional and behavioral problems are intimately linked with recurrent sequences of family interactions is consistent with research on the etiology of childhood aggression and conduct disorder. This research identifies predictable and repetitive cycles of aversive interaction between parents and children and among siblings as contributing factors in the development of antisocial behavior (Patterson, 1982; Patterson & Reid, 1984). The Parent-Child Subsystem Family systems constructs can render the complexity of interactions among multiple family members understandable and predictable, and, therefore, alterable. System principles do not, however, address the central issues and topics around which family interactions occur, namely power/control and affection/intimacy. WARMTH The warmth dimension of parent-child relations reflects verbal and nonverbal behaviors that are emotional in tone, ranging from warmth to rejection. CONTROL Parental control strategies have several important functions in child development. They teach the child frustration tolerance, which is essential to the development of successful interpersonal relations. Control strategies also teach the child socially acceptable norms of behavior, including the avoidance of aggression, cooperation with others, and respect for authority.

PARENTING STYLE Authoritative parents are responsive to the reasonable needs and desires of the child but also make maturity demands appropriate to the child's stage of

development. Parents have clear and well-defined expectations and rules regarding the child's school performance, participation in household chores, and interpersonal behavior with family members, peers, and adults and authority figures outside the home (teachers, other relatives, neighbors, coaches, etc.). Authoritative parenting is associated with a range of positive outcomes, such as positive academic achievement, social responsibility, and positive peer relationships. Authoritarian (high control, low warmth) parents are directive and overcontrolling, and require that children have an unquestioning obedience to parental authority. When a child deviates from parental rules, punishment tends to be severe and is often physical. When teaching the child new skills, behaviors, or tasks, the authoritarian parent is directive, giving direct verbal orders and often physically taking over the activity being taught. Thus, the parent's responsiveness to the child's needs is often overridden by his or her efforts to direct or control those situations. Authoritarian parents also fail to make appropriate maturity demands. By rigidly prescribing child behavior, the child rarely participates in making choices and decisions and therefore has little opportunity to grapple with the consequences of his or her own choices and decisions (Baumrind, 1989). Authoritarian parenting is linked to child aggression, social withdrawal from peers, poor self-confidence, and internalized distress (Baunuind, 1989; Steinberg et al., 1994) as well as continuity of such patterns into adolescence (Baunnind, 199 1; Lamborn, Mounts, Steinberg, & Dornbusch, 1991; Steinberg et al., 1994). Pennissive (high warmth, low control) parents provide their children with little structure and discipline, make few demands for mature behavior, and tolerate even those impulses in children that meet with societal disapproval. Permissive parents are typically warm and responsive but not demanding. Permissive parenting is associated with aggression (Olweus, 1980), impulsivity, and a lack of social responsibility and independence in children (Baumrind, 1989, 1991) and with school misconduct, drug and alcohol use, and heightened orientation toward and value of peer activities and norms in adolescents (Baumrind, 1991; Steinberg et al., 1994). Neglectjul (low warmth, low control) parents offer little affection or discipline to their children and appear to have little concern for or interest in parenting. That is, neglectful parents are neither responsive to the reasonable needs and desires of the youth nor demanding of responsible, age-appropriate behavior with respect to tasks or interpersonal relationships. Of the four parenting types, neglectful parenting is most strongly related to children's

distress. Children from neglectful homes are characterized by poorer adjustment on many indices of functioning than children from permissive or authoritarian homes, and this negative trajectory continues through adolescence, when neglectful parenting is associated with sizable increases in adolescent delinquency and drug use (Steinberg et al., 1994).

Assessing Family Functioning Assessment of family functioning is an ongoing process initiated when the practitioner first meets the family and refined throughout treatment as interventions are implemented and their effects are observed. Together, the practitioner and family members observe and try to tease out the specific family interactions that are the most powerful, proximal predictors of the identified problems. Throughout this process, practitioners do the following: I. Develop hypotheses (e.g., explanations, hunches, or beliefs a practitioner or family member develops regarding the possible causes of the referral problem) regarding the relative contributions of familial factors to problem behaviors. Consistent with MST Principles 4 and 5 (present focused, targeting specific, well-defined problems; targeting sequences of behavior within or between multiple systems), hypotheses focus primarily on observable interactions and behaviors. 2. Gather evidence (i.e., information that was observed, self-reported, or concretely monitored, such as checklists, charts, check-in phone calls by the parent, other family members, school personnel, neighbors, etc., and the practitioner) to support or refute those hypotheses. 3. Implement interventions that target the hypothesized contributing factors. 4. Observe whether the interventions result in changes in problem behaviors. 5. Identify barriers to intervention success. 6. Design interventions to overcome these barriers.

These steps are part of the iterative process of MST case conceptualization and intervention implementation depicted in Figure 2.2 of Chapter 2.

Family-School Linkage Parents' involvement in their children's schooling is an important determinant of academic achievement and psychosocial functioning in school. Therapists should assess, therefore, such parental involvement in school-related activities as the following: Monitoring homework assignments and exam grades. Setting aside a block of time and a quiet place for the child to study after school. Supporting extracurricular school functions. Implementing contingencies that are based on the child's efforts and performance. Providing overt support for teachers' educational demands, behavioral demands, and goals.

PARENTAL ATTITUDES TOWARD EDUCATION Youth academic and behavioral problems can be exacerbated when academic success is not a high priority for the parents. PARENT-SCHOOL CONFLICT Children's school performance usually suffers when conflicts develop between parents and school personnel. Such conflict can be linked with several circumstances, including the following: Miscommunications that can occur when parents and educators are of disparate sociocultural backgrounds (e.g., parents might feel intimidated by or resentful of the educators). Perceived insults or "putdowns" based on previous interactions between the parents and school personnel.

The youth playing the parent off against the school (e.g., convinces his parents that the teacher does not like him and is discriminating against him). Parental perceptions that the school is not committed to meeting the needs of the youth. The perception of school personnel that the parent has little concern for the youth's performance or behavior in school.

FAMILY NAME: Maggie STRENGTHS Individual: Athletic, enjoys sports. Attractive and likeable. Average intelligence. Takes care of siblings. Antisocial behavior limited to aggression. Cares deeply for her mother and wants things to be better at home and school. She responds well to praise. Family: Extended family lives close by and are concerned about M's behavior and home life. Grandmother and aunts willing to do "whatever it takes." mother is seriously concerned about her drug use and M's school and home behavior. Childrens basic needs are met by the mother-she is a survivor. Strong family bond. Peers: Prosocial peers in grandmother's neighborhood. School: Athletic programs. A counselor has a close relationship with Maggie and wants her to do well. Neighborhood Community: Several churches located. in the neighborhood. NEEDS Individual: History of school and community aggression. Physically fights mother. Victim of child sexual abuse. Family: Maternal crack cocaine dependence, Poor monitoring. High conflict, crowded living conditions. Low financial resources. Mother feels hopeless about changing her and M's behavior. Mother has minimal parenting skills. Family is socially isolated. Grandmother has cancer.

Peers: Aggressive and antisocial. peers. Peers have little commitment to school. School: Limited resources. Policy of zero tolerance for threatening teachers. View behavior problems as moral flaw. Quick to expel students. Poor relationship to surrounding community. History of conflict with the family. Neighborhood/Community: Drug infested. Criminal subculture. minimal prosocial outlets. FIGURE 2.1. Initial contact sheet.

Principle 2: Therapeutic Contacts Emphasize the Positive and Use Systemic Strengths as Levers for Change The successful treatment of serious behavioral problems in children is contingent on engaging the family in treatment collaboration and developing a supportive therapeutic alliance. Focusing on family strengths: Sets the stage for cooperation and collaboration by decreasing the untoward effects of negative affect and builds feelings of hope and positive expectations, which are linked with favorable outcomes (Greenberg & Pinsof, 1986). Helps to identify protective factors (e.g., family resources and social supports) that lead to the development of better informed interventions and to solutions that have increased ecological validity and can be sustained by the family over time. Decreases therapist and family frustration by emphasizing problem solving (e.g., focusing on how desired changes can happen as opposed to why problems are so bad). Bolsters the caregiver's confidence, which is a prerequisite for empowerment.

DEVELOPING AND MAINTAINING A STRENGTH FOCUS The MST therapist and treatment team can take several straightforward steps to develop and maintain a strength focus. 1. Mandate that MST therapists, supervisors, and administrators use nonpejorative language in verbal (e.g., informal discussions, and group supervision) and written (e.g., Initial Contact Sheet and case summaries) communications. For example, clients are not viewed as "resistant" but as presenting a "challenge." When therapists have difficulty identifying positive aspects of the family, the treatment team should assist. 2. Teach and use techniques of refraining. For example, when Maggie's mother felt hopeless and overwhelmed and blamed herself for Maggie's difficulties, the therapist responded that the mother may or may not have caused Maggie's problems but she is certainly a critical part of the solution. 3. Use positive reinforcement liberally. The therapist should strive to find "evidence" of client effort and improvement and positively reinforce such, regardless of how small. For example, a client should be reinforced for attending sessions, giving his or her best, and so on. During the initial phase of treatment, Maggie's mother felt considerable apprehension, frustration, and hopelessness. The therapist reminded the mother that she was making important progress in helping her daughter by meeting with the therapist and helping to plan for changes. 4. Incorporate and maintain a problem-solving stance. A problem-solving stance emphasizes the examination of factors that can increase the probability of success as opposed to detailing what failed. For example, when barriers to success arise in treatment, the therapist, family, and MST treatment team should focus their attention on understanding the fit of the barrier, developing hypotheses, and testing the hypotheses by designing interventions to overcome the barrier. In Maggie's case, the mother's drug use was a constant barrier to treatment, and she refused to enter an intensive specialized treatment program for cocaine abuse. Instead of continuing to focus on the barrier presented by this refusal, the therapist took a different tack-enlisting the support of extended family to help serve as parental surrogates and attempting to identify and understand the events and situations leading up to and following the mother's cocaine use (i.e., closely examining the fit of the cocaine use).

5. Provide hope. Many families referred for MST are told repeatedly by family, friends, and social service professionals "how bad things are" for the child and family. To counter this pessimistic stance, the therapist should, through optimism and a "can do" attitude, engender hope among family members and attempt to energize the family and key members of their social ecology to effect change.

6. Find and emphasize what the family does well. The therapist should focus on identifying and encouraging what the family does well. To facilitate this process, breaking large, seemingly insurmountable tasks into small steps is often useful. With Maggie and her mother, for example, the therapist helped to set small, "achievable" daily homework assignments and goals (e.g., saying hello to one another when Maggie got home from school and getting Maggie's homework to grandmother to be checked). These goals were designed to provide incremental progress toward the larger goals of treatment.

The goals of the meeting between the therapist, parents, and school personnel, therefore, are to do the following: 1 . Clarify that all parties have the youth's best interest at heart. 2. Explain the rationale (i.e., fit) of the proposed interventions to all parties. 3. Provide an opportunity to revise the proposed interventions, pending additional input from school personnel (assuming that any revisions are approved by the parents and therapist). 4. Delineate the exact responsibilities of each party vis-a-vis the interventions, with the parents assuming the bulk of the responsibility. 5. Develop a system for monitoring implementation and outcome of the interventions. 6. Develop a system for providing all parties with feedback regarding the outcomes. 7. Delineate strategies for revising the school-related intervention protocol, with the parents and therapists taking responsibility for such.

When and How to Conduct Individually Oriented Interventions In our experience, team (i.e., practitioner and clinical supervisor) decisions to pursue individual treatment with parent figures most often (1) pertain to problems that interfere with parental functioning, such as depression, anxiety disorders, and substance abuse; and (2) are made at two "ends" of the MST treatment period. These two ends are: 1. Early in treatment, if the parent figure's functioning is compromised so frequently or to such an extent that the practitioner is unable to develop a working alliance, identify the parent's treatment goals, or engage the parent in making even minor changes toward a goal he or she has identified as important. 2. Well into treatment, when interventions targeting intrafamilial (parent-child, marital, kin) or extrafamilial (family-school, peer, neighborhood) interactions have been implemented inconsistently or implemented with poor results, and specific aspects of the parent's functioning are identified as critical barriers to implementation or success. With respect to adolescents, four types of situations can warrant the implementation of individual interventions. These are: 5. When a youth continues to display serious aggressive or impulsive behaviors in one or more contexts (e.g., in the classroom, with certain peers, and with siblings) after systemic interventions have been consistently implemented by parents, teachers, and other relevant players in the youth's natural ecology. 6. When a youth with biologically influenced difficulties (e.g., ADHD, bipolar disorder, or clinical depression) is consistently taking appropriately prescribed medication and well-implemented ecological interventions are in place, yet, problems with impulsive or aggressive behavior continue to occur at home, in school, or with peers. 7. When the sequelae of victimization (i.e., physical abuse, sexual abuse, and criminal victimization) contribute to referral problems.

8. When intensive and comprehensive efforts to engage caregivers in changing parenting practices or other aspects of the youth's ecology are unsuccessful, efforts to overcome barriers to change are unsuccessful, and the adolescent will continue to live in a home in which the lack of favorable clinical change will exacerbate the identified problems. Source: Henggler, S. et. al. ( 1998). Multisystemic Therapy. New York, Guilford press.