Couple & Family Therapy : An Integrative Map of the Territory Jay L Lebow Chapter 2 The Integrative Perspective

Introduction Two Approaches to Family Therapy (Lebow, 2014) Introduction Two Approaches to Family Therapy Specific Treatment Models Insular Communities Protocols One theory & One Set of Interventions Integrative One Coherent Field Which concepts/interventions apply to which cases? Trend

Finding the Essence of What Matters (Lebow, 2014) Finding the Essence of What Matters Distinguishing & Sharing Benefits of Distinguishing between specific approaches Benefits of Sharing and integrating approaches

Benefits of Specific Approaches (Lebow, 2014) Benefits of Specific Approaches Structure for Learning Group of Colleagues Identifiable Brand Personal Identification Consistency Across Providers Clinical Trails of Manualized Treatment

Trend Toward Specific Integrative Treatments (Lebow, 2014) Trend Toward Specific Integrative Treatments Recognizes limitations of more pure models Assimilation of New Elements Blending of Theories

Some Integrated Specific Models (Lebow, 2014) Some Integrated Specific Models Multidimensional Family Therapy (Little, 2009) Structural CBT Functional Family Therapy Integrative Behavioral Couples Therapy Behavioral Cognitive Emotion-Focused

Types of Integration Theoretical Integration Technical Eclecticism (Lebow, 2014) Types of Integration Theoretical Integration Technical Eclecticism Common Factors Assimilation

Roots of Integration Wide range of choices to match specific clients (Lebow, 2014) Roots of Integration Wide range of choices to match specific clients Zeitgeist of Our Time: Postmodern Multiculturalism Communication Between Models/Theories Requirements of Practice Emergence of Research: No one model is superior Common Factors

Benefits of Integration (Lebow, 2014) Benefits of Integration Broad Theoretical Base Sophisticated Explanations Range of Experiences Flexibility Dimensions Cognitions Emotions…. “The therapist looking for a particular type of problem dimension will likely find that type of problem” (p. 32)

Benefits of Integration (cont.) (Lebow, 2014) Benefits of Integration (cont.) Broad Range of Needs Met Therapist Affects Grows in Many Directions Find a fit Personality Idea of problem development Ideas of solutions

Benefits of Integration (cont.) (Lebow, 2014) Benefits of Integration (cont.) Integrate what works New Techniques Supported Approaches Greater Objectivity Advantages in Training Open attitude Flexibility from the start Negates “correct vs. incorrect”

Potential Problems Lack of Cohesion Lack of Consistency (Lebow, 2014) Potential Problems Lack of Cohesion Theoretical Basis Fads Potpourri of techniques Solution: Integration Lack of Consistency Jumps between approaches/terms Ex: Witnessing Unclear direction Solution: Roadmaps

Potential Problems (cont.) (Lebow, 2014) Potential Problems (cont.) Utopian Views & Grandiose Goals Giant tool kit Broad Goals Solution: Evidence Based / Appraisals of Goals Complexity Reduction in further development of theory & practice in literature

Potential Problems (cont.) (Lebow, 2014) Potential Problems (cont.) Evidence of Efficacy Difficult to understand Rarely Studied Lack of Specificity Targeted problems are known to have effective treatment Solution: incorporation of empirically supported treatments

Underlying Conceptual Lens (Lebow, 2014) Underlying Conceptual Lens

Overarching Conceptual Lens of Couple & Family Therapy (Lebow, 2014) Overarching Conceptual Lens of Couple & Family Therapy Multidisciplinary Applicable to Most Not Definitive Topics: Bio-behavioral-psycho-social Foundation Systematic Understandings Family Structure Communication Family Life Cycle Ethnicity Culture & Larger Systems Social Roles Gender Social Exchange Social Learning Postmodern Viewpoint Individual Functioning and Personality Intentionality Healing Family

Bio-Behavioral-Psycho-Social Foundation (Lebow, 2014) Bio-Behavioral-Psycho-Social Foundation Biology Well established that biology impacts individual and family functioning What are potential effects of Biology on Family? Limits: How important is it? Circular Processes Beware of the pitfalls of the Medical Model

Bio-Behavioral-Psycho-Social Foundation (cont.) (Lebow, 2014) Bio-Behavioral-Psycho-Social Foundation (cont.) Social Psychology & Sociology Classical conditioning, operant conditioning, modeling, covert learning, social learning, social roles, social exchange, Etc. Interpersonal Skills Collaborative problem solving Social exchange Intimacy

Bio-Behavioral-Psycho-Social Foundation (cont.) (Lebow, 2014) Bio-Behavioral-Psycho-Social Foundation (cont.) Individual Psychological Processes Cognition, affect, internal psychodynamics, mindfulness “Both / And” Cyclical Process

General Systems Theory (Lebow, 2014) General Systems Theory Importance of they system with mutually influencing parts The whole is more than the sum of it’s parts To understand a part, you must understand it’s relationship to all other parts All behavior serves a function in the context in which it developed A Man Quacking at a Duck To understand a behavior, you must understand it’s function

General Systems Theory (cont.) (Lebow, 2014) General Systems Theory (cont.) Circular View of Causality Mutual interaction Bidirectional influence To understand one person’s behavior, you must understand how others are behaving Limit: Be careful to not overemphasize the system’s responsibility Ex: Family Violence

Cybernetics Science of Communication & Control (Lebow, 2014) Cybernetics Science of Communication & Control Emphasizes that systems are Self-correctional Influenced by feedback Morphogenesis & Homeostasis Types of Feedback: Positive – input that sparks change Negative – input that reduces change

Family Structure (Minuchin, 1974) (Lebow, 2014) Family Structure (Minuchin, 1974) Boundary – who is in what operations Alliance – who sides with whom Distribution of Power – relative impact of each person on the system

(Lebow, 2014) Communication “One cannot not communicate” (Watzlawick et al., 1967, p. 48) Communication processes are an essential focus of couple and family work

Family Life Cycle Typical Development Culture is vital (Lebow, 2014) Family Life Cycle Typical Development Range of Options Ex: Monitoring children 24/7 Culture is vital Non-marriage, Divorce, Remarriage play major roles “Increasingly Unanchored” (p. 45) Predictable Issues Couple Meets Courtship Commitment Children Children become Adolescents Children become Adults Grandchildren

Ethnicity, Culture, and the Larger System (Lebow, 2014) Ethnicity, Culture, and the Larger System Differences in: Visions of healthy living Optimal ways to communicate & connect What constitutes a problem Important to know cultural norms Ex: grief Ex: enmeshment

(Lebow, 2014) Social Roles “rights, obligations, behaviors, beliefs, and norms envisioned by actors about various stations in social situations” (p. 47) Role of Grandmother? Smooth Function & Role Strain Each member expected to fulfill role Evaluated May experience issues when roles are unwanted, stagnant in times of change, or the person is unable to fulfil the role

Gender Discussion of gender & power Mutual Understanding & Balance (Lebow, 2014) Gender Discussion of gender & power Mutual Understanding & Balance Culture Specific

Social Exchange (Thibaut & Kelly, 1959) (Lebow, 2014) Social Exchange (Thibaut & Kelly, 1959) Individuals maximize their cost-benefit in exchanges “family members, when self-aware, will negotiate and carry out rational exchanges of rewards and punishments” (p. 48) Limitations: Emotional and psychodynamic forces Impaired by conflict

Social Learning (Bandura, 1977) (Lebow, 2014) Social Learning (Bandura, 1977) People learn primarily in a social context Modeling & covert learning Reinforcements and punishments Useful in learning and practicing skills like communication and problem solving.

Post-modern Viewpoints (Lebow, 2014) Post-modern Viewpoints Knowledge is subjective Social Constructivism Who is the expert? Social Justice

Individual Functioning (Lebow, 2014) Individual Functioning Personality – “Big Five” Openness Consciousness Extraversion Agreeableness Novelty Seeking Shaping Behavior & Changing Thoughts Processing Felt Emotion Psychodynamics

Intentionality & Healing (Lebow, 2014) Intentionality & Healing Intentionality Families purposefully move toward goals Act consistently with values Healing Connection Heals Corrective experiences take place in family context

(Lebow, 2014) Reference Lebow, J. L. (2014). Couple and family therapy: An integrative map of the territory. Washington, DC: APA books.