Family Therapy

A systemic approach
The family as a system

 Systems are composed of units who have some

relationship to each other and are organized
around those relationships
 Solar system
 Educational system

 A change in one part causes a change in another

The etiology of problems
 Family characteristics: Problems (even an individual’s
psychological symptoms) are assumed to be caused
by a dysfunctional family characteristic
 family boundaries/structure (adaptability and cohesion)
 the nature of family interactions

 Family Homeostasis: When disruption occurs, family

members try to regain a stable environment by using
strategies that decrease stress and restore balance.
These strategies are not always adaptive in long-run.
 Family characteristics: Boundaries

Boundaries are implicit family

rules that determine how family
members relate to each other,
including who talks to (or spends
time with) whom, how decisions
are made and by whom, and how
much family members know about
each other’s lives.
Family characteristics: Boundaries/Cohesion

 Enmeshment (very low differentiation)

 People are enmeshed (or fused) when they are unable to
think or act autonomously.
 People who are not enmeshed are autonomous and have
emotional separation from their family.
 A person’s level of differentiation is often related to his or her
parents’ level of differentiation. It’s often transgenerational.
 People with low levels of differentiation are more reactive to
environmental stressors. When under stress they are more
likely to try to resolve it by:
 Withdrawal
 Destructive conflict
 Dysfunction
 Triangulation
 Disengagement (very high differentiation)
Family Adaptability

 Adaptability refers to the family’s rules about

who does what and it’s ability to adapt as
necessary
 When there are few rules (or rules are not
enforced), family functioning is chaotic
 When the rules are too rigid, families have
trouble adapting to change
Family Circumplex Model
 The nature of change

 Change/healing occurs when family members

1) Gain insight about their dynamics

2) Change repetitive patterns that hinder the family

 Learn more effective ways of communicating

 Change family roles

 Develop more healthy boundaries

The Initial Interview

 Pre-session Planning: The therapist and family

determine in advance who will attend the session.

 The Joining Stage: The therapist joins with the family,

taking on their affective tone, tempo, language and
structure.

 The Problem Statement Stage: Who gets to initially

frame the “problem”? Sometimes the person who has
the least involvement with the problem is addressed
first.
Initial Interview (continued)

 The Interaction Stage: The therapist focuses in on determining

the patterns of interaction sustaining the problem.

 In-Session Conference: The therapist leaves the family for a few

minutes and confers with observers or takes a moment alone to
think about what has been said and how that relates to the
therapist's hypothesis regarding the problem.

 Goal Setting Stage: The therapist reaches an agreement with

the family on a solvable problem, stated in behavioral terms so
that all involved will know when the problem has been solved.

 Ending Stage: The therapist sets the next appointment and

indicates which family members will be present.

 Post-session: Debriefing and processing

Family Therapy Assessment Techniques

 Family Interview

 Circular Questioning: The same question is asked of each

family member.

 Family Sculpting: Assessment tool that examines power and

closeness in a family by asking each family member to
physically arrange all other family members in order of
relationships (or in reference to a particular salient event).

 Reenactment: Asking the family to act out a situation rather

than describe it verbally.

 Genogram: Gives a picture of three or more generations (like

a family tree) and notes important family dynamics, rules,
patterns, mental health issues, etc.
Stan’s
Genogram
What the genogram tells us
 Mom married Dad (after he stopped drinking and
went to AA) but they had contentious life
 Mom’s Dad drank (and went to AA)

 Mom’s Mom drank (but denied problem)

 Matt, Stan’s sisters husband drinks as does Stan

(and Stan’s Mom has problem with them both)
 Karl the younger brother is close to Stan

 Stan is distant or disengaged from Dad & older

brother
 Family Therapy Intervention Techniques

 Reframing: The problem must be put into solvable,

behavioral terms, be referenced as a family problem
and not just the problem of one family member, and be
put into positive terms (i.e., what will happen, not what
won’t).

 Giving Directives: Creating or selecting an intervention

that will impact the presenting problem.
 Modifying the structure
 Switching roles
Family Therapy Techniques (cont.)

 Rituals: Symbolic acts that help the family move. (e.g.

burying a box that contains family anger.)

 Ordeals: An ordeal is a behavior that is more

obnoxious, frustrating, and time consuming than the
behavior that is considered the symptom. When the
symptom behavior occurs, the family is instructed to
perform the ordeal.

 Ambiguous Assignments: Helps break down linear

thinking and causes the family to be more creative in
problem solving.
Major Family Therapies

 1950’s: Several psychologists break away from psychodynamics

and argue that dysfunctional behavior is rooted in the individual’s
past and present family life.

 Jay Haley (and others) develop strategic family therapy.

 Virginia Satir develops conjoint family therapy

 Salvador Minuchin develops structural family therapy.

 Murray Bowens develops transgenerational family therapy.

 Carl Whitakers develops experiential family therapy.

Demo 1: A house divided

Demo 2: Adrian, Judy, and Pam