counseling family therapy

Counseling

Family Therapy

Şerif Türkkal (MSc)

Eastern Mediterranean University

Şerif Türkkal (MSc), 2018, PSYC447 1

Family Therapy

• Similar to couples therapy, but evolved for different reasons

• A number of therapists noticed that a number of those who made significant improvements in individual therapy or institutional treatment often had a relapse when they returned to their families – this led to an emphasis on the family environment and parent-child interactions as causes of maladaptive behavior

• The source of the problems are not internal processes but interpersonal process


Family Therapy• Family, ragardless of its number and type, is a system which is

formed by the sum of its smaller elements.• In order to understand its elements we need to focus on the system

itself. • «Individual or family problems cannot be resolved without first

understanding the client's larger system or environment.»

• Today, there are various combinations of families• Nuclear Family• Single parent families• Extended family• Seperated families• Stepfamily• Grandparent family• Childless family


This perspective is grounded on the assumption that individuals’ problematic behavior may…

1. Serve a function or purpose for the family

2. Be unintentionally maintained by family

3. Be a function of the familiy’s inability to operate productively, especially during developmental transitions

4. Be a symptom of dysfuntional patterns handed down across generations

So rather than approaching the problems with intrapsychic frameworks, systems perspective uses an interpersonal understanding

(Corey, 2012)


Family life-cycle in a traditional family system with kids …• Independence

• Early marriage years

• Pregnancy

• Parenthood

• School years of children

• Adolescence

• Adult child leaving home

• Retirement

• ...


Family structure

• Closed systems• Usually have rigid boundaries• Differentiation and independence of the members and subsytems are not

very possible

• Open systems• Clear boundaries• Rigid enough to give sense of security and flexible enough to support

independence

• Random systems• Rules and boundaries are developed situationally and randomly• Family system is a slippery slope, in which nothing is fixed and predictable


Three Basic Family Structures:

Şerif Türkkal (Msc), PSKL447 13

Closed Open Random

Distance Fixed Flexible Disorganized

Time Fixed Flexible Disorganized

Effort Fixed Flexible Disorganized

Power Hierarchic Shared Free

• These structures should not be perceived as categorical. Family structures should be assessed on a continuum.

Pioneers of Family Therapy

• Murray Bowen, Family Systems Therapy

• Virginia Satir, Experiential Family Therapy

• Salvador Minuchen, Structural Family Therapy


Murray Bowen(1913-1990)


Bowen Family Systems Theory...

«We have less autonomy in our lives than we assume…»


Unresolved emotioanl reactivity to our parents is the most important unfinished bussiness of our lives

Bowen Family Systems Theory...

• His theory is also known as Multigenerational Family Therapy

• Multigenerational transmission processes• Undifferentiated family ego mass

• Family as a multigenerational network of relationships, shapes the interplay of individuality and togetherness

• «Transmission of information across generations on several interconnected levels, ranging from the conscious teaching and learning of rules and regulations to the automatic and unconscious programming of emotional reactions and behaviors that, collectively, define the individual’s view of the world and shapes sense of self»


Bowen Family Systems Theory

Family as a multigenerational network of relationships, shapes the interplay of individuality and togetherness through these following processes:

• Multigenerational transmission process• Patterns of interpersonal relationships connect family members across generations

• Problems manifested in one’s current family will not significantly change unless, patterns in one’s family of origin are understood and directly challanged

• Unresolved emotional reactivity to one’s family should be addressed in order to achieve a mature and unique personality

• Differentiation of the self - ability to be flexible and act wisely even in the face of anxiety despite the influence of multigenerational transmission process on self.


Differentiation of the self…

«Highly differentiated persons developed stable, productive nuclear families that contributed to society, whereas, low differentiated individuals raised children over generations who were more susceptible to social illness and psychological problems»

(Bowen 1978; Kerr and Bowen, 1988)


Two polarities of human nature...

Individuality-Togetherness


Individuality-Distance-

Togetherness-Closeness-

Differentiated Self

Differentiation of the self:

• Family as a multigenerational network of relationships, shapes the interplay of individuality and togetherness• How we reconcile these polarities depends on the extent to which we have

learned to manage emotionality (differentiation of self)

• Differentiation of the self - ability to be flexible and act wisely even in the face of anxiety even in face of anxiety and stress• A differentiated mature self can balance individuality and togetherness in

his/her relationships with others• A differentiated self implies mature ability to manage emotionality • Self-definition and self-regulation



• If differentiation of the self is not achieved Emotional over-involvement / Emotional cutoff

• Sibling position: «Personality is the reportoire of strategies siblings use to compete with eachother to secure a place in the family»



• Triangles • Patterns of interaction that reduce conflict and pressure within the dyad• A three-person (sometimes not a person) emotional configuration• When anxiety increases a two person interaction may lose its stability. Thus,

they invole a third person to regulate its stability• Greater anxietymore closeness or distance• Can be used for alliance and support building as well (divorced parents coming

together to support their kid)

• A series of interlocking triangles are possible, when triad can no longer contain anxiety. So more people are triangled.

• Same traingling patterns may occur in a family across generations

• Genogram


Basic symbols used in geograms


Genogram symbols for relationship dynamic


Overly close

. . . . . Distant

Conflictual

Emotional cutoff

Şerif Türkkal (MSc), 2018, PSYC447

33


Source:

https://www.genopro.com/articles/death-distance-dynamic-bush-family/



Virginia Satir (1916-1988)


Satir Transformational Systemic Therapy (STST)Virginia Satir• Maturation:

• “The most important concept and touchstone in therapy is maturation: the state in which a given human being is fully in charge of himself, […]able to make choices and decisions based on accurate perceptions about himself, others and the context…while acknowledging, owning and accepting responsibility for those choices and decisions” (Conjoint Family Therapy, 1964, pp. 117, 118).


Satir Transformational Systemic Therapy (STST)Virginia Satir

In her unfinished manuscript, The Third Birth: Becoming Your Own Decision-Maker, Satir states:

«The evolution to becoming a decision maker … is the time when we recognize that we are the center of our own universe, and accept all the responsibility, privilege, and risk that goes with it» (Satir, undated, p. 20).


Satir argues that the third birth, being a decision maker, opens up the possibility for a relationship between two wholes rather than two holes. A connection of two congruent selves where each enjoys the inalienableFive Freedoms:

1. The freedom to see and hear what is here,

Instead of what should be, was, or will be

2. The freedom to say what you feel and think,

Instead of what you should

3. The freedom to feel what you feel,

Instead of what you ought

4. The freedom to ask for what you want,

Instead of always waiting for permission

5. The freedom to take risks on your own behalf,

Instead of choosing to be only “secure” and not rocking the

boat (Satir, Banmen, Gerber, & Gomori, 1991, p. 62).


Satir Transformational Systemic Therapy (STST)Virginia SatirThe beliefs that help guide the therapist (Satir et al., 1991) 1. There is a strong belief that change is always possible, even if

change can only take place inside of the person. These changes

might include feelings, perceptions, and expectations.

2. Therapy sessions need to be experiential in order to bring about

second level change. This involves a change in being, not only

in doing or feeling.

3. The problem is not the problem; coping is the problem. Therefore, therapy focuses on improving one’s coping instead of just

solving one’s problems.Şerif Türkkal (MSc), 2018, PSYC447 42

Satir Transformational Systemic Therapy (STST)Virginia Satir

4. Feelings belong to us and, therefore, we can learn to change

them, manage them, and enjoy them.

5. Therapy sets positively directional goals and resolves the impact

of negative experiences.

6. Therapy is systemic, considers both intrapsychic and interactive.

7. People have the resources they need to cope and grow. Therapy

is one vehicle to harness these resources to help people change.

8. Most people choose familiarity over the discomfort or fear of

change, especially during times of stress.


The Satir model focuses on three major areas for therapeutic intervention:

1. The Intrapsychic, 2. The Interactive, 3. The Family-of-origin.


The Satir model focuses on three major areas for therapeutic intervention: 1. The Intrapsychic: to explore the internal experience of the client.

• It is important to keep the story to a minimum and only use the story to create thenecessary context in order to evaluate the internal experiences of the client therapeutic work will take place.

• Iceberg Metaphor• a) behavior, b) perceptions, c) expectations, d) yearnings, and e) the Self• These components are interactive and systemic

• This will involve asking various questions related to the person’s feelings, perceptions, expectations, and yearnings.

• Sample questions might include the following: • “How do you feel right now?” • “How did you feel when this problem happened?” • “How did you express or handle your feelings?” • “How do you see yourself now that your wife left?” • “How do you see your wife now that she left you?*



It is aimed to help clients experience• some harmony, • some self-worth, and • some sense of accepting


2. The Interactive, • The Satir model looks at people’s relationships in terms of sameness and

differences. Satir used to say that sameness attracts and differences help us grow. The Satir model advocates resolving differences from a congruent place of interacting.

• Differences are handled in various ways. There are five ways that people might use to handle differences.


2. The Interactive: Five ways of how differences are approached1. Conflict as a solution. This method of handling differences includes physical or verbal fights

and disagreements. It is an either/or position with only one right possibility. It often builds on the polarity of right and wrong. In the hierarchical model, it becomes a power struggle. As might seem obvious, the Satir model does not advocate this approach to resolving conflict within, between, nor among people.

2. Denial as a solution. Even though differences exist, people using denial either verbally or non-verbally have decided to avoid the differences. For example, people never share or discuss their religious or political views because of potential disagreements or conflict. They withhold their views and might, instead, withdraw from each other and avoid intimacy and closeness.

3. Compromise as a solution. When people compromise, both parties give in and both win and lose as they choose something that possibly neither wants, but both feel they can accept. It is sometimes a 50/50 settlement. Very often, in therapy, this level of dealing with differences is the beginning of reconnecting with each other.



2. The Interactive: Five ways of how differences are approached4. Resolution as an answer. At this level of dealing with differences, both parties win.

The resolution usually takes place at a deeper level of connectedness, at the level of yearnings. Here, people accept each other, both with positive intentions and good will. Often, resolving major differences needs a third party to help the individuals work through some of the disappointments, anger, fear, and hurt that might be lingering.

5. Growth as an outcome. Finally, when we look at how differences help people grow, we find that through understanding, acceptance, and risk-taking, clients can learn to incorporate some of their differences into their lives. In therapy, differences often trigger the survival needs and, therefore, differences become a life/death issue between couples or among family members. Example: “I liked opera and she liked ballet. Now, we both like opera and ballet.”




3. The Family-of-origin• She also used an intergenerational model but she worked to

bring family patterns to life in the present through some techniques like sculpting and family reconstructions

• Reclaiming the resources one has received from one’s family-of-origin.

• Family map of the client’s family-of-origin.• The map includes two major time frames:

• the factual present and the perceptual past.


“Survival Stances.”

• “The problem is not the problem, coping is the problem.”

• After observing a large number of families interacting, or communicating, she formulated some basic behavior into patterns which she called “survival stances.”

• Coping stances are modes of surviving under emotional stress.• Analyzing coping stances correctly helps to effectively connect with the clients

• These survival/coping stances are• 1) placating, • 2) blaming, • 3) super-reasonable, • 4) irrelevant

• Most people have one major coping stance that they use when they are under stress. Many people actually use all four coping stances depending on the circumstances and relationships in which they find themselves.


Techniques in Satir’s Model

• She also used an intergenerational model but she worked to bring family patterns to life in the present through some techniques like sculpting and family reconstructions

• The basic goal is to update new possible responses to past, present, and future stressors through the use of :• Sculpture,

• Sculpting, which can be utilized also with individuals, is particularly helpful in externalizing the communication patterns among couples or families

• Psychodrama,• Guided Fantasy, • Metaphor


The primary technique in Satir’s Model: Family Sculpting«I want you to pretend like you’re a sculptor and your family’s made of

clay. You can put them into any position you want. It can be turned around, it can be way over here, it can be down low or up high. Their arms can be up, they can be doing things with their hands. I want you

to just show me your picture of the family, pretending you’re the sculptor. Now, clay has to stay where it’s put, so you sculpt everybody,

including yourself and how you see the family right now.»


Şerif Türkkal (MSc), 2018, PSYC44765

Salvador Minuchin (1921-2017)


Salvador Minuchin: Structural Family Therapy

• Discussions around etiological history, in any case, are largely academic from the perspective of structural family therapy, whose interest is focused on the current supportive relation between system and problem behavior. The model shares with other systemic approaches the radical idea that knowledge of the origins of a problem is largely irrelevant for the process of therapeutic change (Minuchin & Fishman, 1979).


Salvador Minuchin: Structural Family TherapyFactors involved in family structures:

• Transactional patterns

• Subsystems

• Boundaries


Salvador Minuchin: Structural Family TherapyTransactional patterns

• Transactional patterns informs us about family structure, boundaries between members and subsystems, groupings and coalitions(Goldenberg ve Goldenberg, 1996). • Recurring relationship patterns create transactional patterns

• How the different parts of a system interact with each other, how the balance is enabled, what are the communicational styles in the family?

• Which communication styles create which consequences? • Which members/subsystems relate with whom and how?


Salvador Minuchin: Structural Family TherapyTransactional patterns

• Sub-systems• Parents

• Kid(s)/Siblings

• Power issue and hierarchical structure

• Boundaries• Barriers which protect integrity of family as a whole, sub-systems and

individual members



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Salvador Minuchin: Structural Family TherapyTherapy Process and Techniques

• When restructuring dysfunctional family structures, an active role is given to family therapists (Minuchin, 1974).• «An effective structural family therapist is

always sensitive about timing, active and energetic»


(Goldenberg and Goldenberg, 1996)

Salvador Minuchin: Structural Family TherapyTherapy Process and Techniques• Joining techniques

• In joining, the therapist becomes accepted as such by the family, and remains in that position for the duration of treatment; although the joining process is more evident during the initial phase of therapy, the maintenance of a working relationship to the family is one of the constant features in the thera-pist’s job.

• Maintenance is one of the techniques used in joining. The therapist lets himself be organized by the basic rules that regulate the transactional process in the specific family system. • If a four-generation family presents a rigid hierarchical structure, the therapist may find

it advisable to approach the great-grandmother first and then to proceed downward.


Salvador Minuchin: Structural Family TherapyTherapy Process and Techniques• Techniques for Disequilibration

• Enactment, boundary-making, reframing, punctuation and unbalancing

• Enactment is the actualization of transactional patterns under the control of the therapist. Enactment is also the vehicle through which the therapist introduces disruption in the existent patterns, probing the system’s ability to accommodate to different rules and ultimately forcing the experimentation of alternative, more functional rules. Change is expected to occur as a result of dealing with the problems, rather than talking about them.

• Boundary making is a special case of enactment, in which the therapist defines areas of interaction that he rules open to certain members but closed to others.


How can you get training in Family Therapy??

• Please check the websites for the following associations:• International Family Therapy Association: IFTA

• European Family Therapy Association: EFTA

• Turkey: Aile ve Evlilik Terapileri Derneği (AETD)

• Turkey: Çift ve Aile Terapileri Derneği (ÇATED)*• Currently active in Turkey


Final exam

• Exam Format• Multiple choice• Case questions

• Weight: • %50 percent

• Subjects:• Initial Stage (SOAP Notes)• Working Stage• Family Therapy• Extra reading materials are available on opencourses (The materials may involve

more details than we studied in class. You are only responsible from what is covered in class!)


counseling family therapy

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