1. Family Systems Theory and Therapy

2. Systems Model The following slides are general slides on the Systems Theory Model

3. Theoretical Developments and Principles A metaphor for understanding Family Systems – Cybernetics Computer and engineer term to understand machine systems Evaluate efficiency and stability of the machine Understand how systems communicated and used feedback loops to achieve regulation If you change one component the feedback loop can change the system

4. Theoretical Developments and Principles Bateson took the Cybernetics model and applied it to social science Bateson focused on human communication and viewed families as cybernetic systems Families can achieve self regulation and stability through their norms Bateson assessed family communication patterns associated with psychopathology Assessed families of schizophrenia

5. Theoretical Developments and Principles General Family Theory Reaction against cybernetics model (rule bound, mechanical, rigid). Ludwig and von Bertalanffy: human systems function more like organisms and less like machines – All parts of the system can impact other parts – Subsystems contribute to the larger systemic functioning – Families contain subsystems and simultaneously function as a part of a larger system

6. Theoretical Developments and Principles First-and Second-Order Change – First-order change: making changes to symptoms Involves making surface behavioral changes while ignoring underlying family system dynamics. Example dad getting AA to get sober. – Second-order change: involves changing deeper interactional patterns in the family. What’s happening in the family that maintains Dad’s drinking? What purpose does Dad’s drinking serve for the family? What interactions are supporting the system?

7. Theoretical Developments and Principles Homeostasis: by nature families strive for homeostasis or a sense of balance and equilibrium that’s consistent and predictable Achieving homeostatic balance creates safety and familiarity for families. Sometimes old patterns that are familiar to a family may be uncomfortable but feel safer than new and unknown patterns Therapy can create a temporary imbalance and families need to accommodate to change

8. Theoretical Developments and Principles Attending to Interaction Patterns – Subsystems – Boundaries – Coalitions – Alliances – Triangles – hierarchies – Roles – rules

9. Theoretical Developments and Principles Subsystems: most common in families are parental units and sibling units. Look into the interactions between these subsystems to assess the relationships that are maintaining the symptom. Boundaries: Rigid versus diffuse – Rigid: difficult to change or penetrate, family won’t accept influence and tries to keep the same impenetrable boundary across time and context. Ie., 14 yrs old curfew, goes to college comes back and parents expect same curfew.

10. Theoretical Developments and Principles Boundaries: – Diffuse: loose, open, absent boundaries. – i.e., marital couple having problems and mother turns to child to vent about father. Child gives mom advice and companion.

11. Theoretical Developments and Principles Family shifts during conflict: Alliance: person feels alone in the conflict, no one to validate their experience, in distress seeks alliance. Tries to gain connection and support from another. Mother seeks comfort from daughter about something father is doing Coalition: occurs when two family members side together against a third. Daughter sides with mother and they bind together against dad. Triangulation: a dyad in conflict pulls in a third party. The third party holds the focus to relieve relationship distress. The dyad ignores their own struggle and come together as they place energy into the third party. Dyad usually pulls a more vulnerable less powerful family member. Therapist: “if your daughter weren’t the problem what would the problem be?”

12. Theoretical Developments and Principles Therapists should understand family roles and rules Minuchin would ask families: – Who’s the sheriff in this family? – Who’s the lawyer? – Who’s the social worker? – Other family roles: caretaker, breadwinner, disciplinarian, cook, protector..etc.

13. Theoretical Developments and Principles Family rules – Provide predictability – Set expectations for behavior (spoken / unspoken) – Overt rules: curfews, bed time, chores – Covert rules: don’t talk about mom’s drinking, when you are sad/ keep it to yourself, don’t get angry…etc

14. Theoretical Developments and Principles When working with families in therapy the therapist should assess the previously mentioned – Rules – Roles – Alignments – Coalitions – Triangulations – Boundaries – subsystems

15. Bowen Model The following slides are in regards to Bowen’s Model

16. Intergenerational Family Therapy Bowen’s Model Intergenerational Family Therapy – Has psychodynamic foundations – Bowen’s model and concepts of his therapy Differentiation: balance the need for togetherness and the need for autonomy. Self (avoid isolation)---------X-----------together (avoid emeshed) this concept has two aspects. First, intrapersonal which means the ability to separate thoughts from feelings in order to respond rather than react. Second, interpersonal which means the ability to know where oneself ends and another begins without loss of self. If partner gets feelings hurt not react but tolerate tension and than respond

17. Intergenerational Family Therapy Bowen’s Model Bowen’s model continued – Emotionally cutoff: a situation in which a person no longer emotionally engages with another in order to manage anxiety No longer seeing or speaking to a person Sign of lower level of differentiation Person is so fused with the other that they must physically separate to be comfortable

18. Intergenerational Family Therapy Bowen’s Model Emotional triangles: Bowen suggest that this is one of the most important dynamics to assess because they are the basic building blocks of the families. A dyad draws a third person to stabilize the primary dyad. Especially when there is tension in the dyad. The more rigid the triangle the greater the problems. Classic triangle= mother who becomes overinvolved with children to reduce unresolved tension in the marriage

19. Intergenerational Family Therapy Bowen’s Model Family Projection: parents project their undesired feelings onto one or more children which causes decreased differentiation in subsequent generations. Most common is for a mom to project her anxiety onto one child, focusing all of her attention on this child to soothe her anxiety.

20. Intergenerational Family Therapy Bowen’s Model Bowen model: – Use of genogram= family assessment instrument and an intervention – Genogram helps therapist identify intergenerational patterns that surround the problem such as: Parenting Managing conflict Balancing autonomy and togetherness Assist clients in seeing family patterns

21. Intergenerational Family Therapy Bowen’s Model In Bowen’s model there are few interventions. The Genogram is the main intervention. Therapist might model differentiation in the session. If client wants therapist to take sides the therapist will help client tolerate anxiety by modeling differentiation Therapist’s own level of differentiation is crucial to facilitating the change process. – Therapist does not rush into rescue, not react to attacks, but guides client in process of separating self from others and thoughts from feelings

22. Intergenerational Family Therapy Bowen’s Model Multigenerational Transmission Process: refers to the fact that transmission processes from prior generations are present and alive in current family emotional systems. Children may emerge with higher, equal, or lower levels of differentiation than their parents. Family with severe emotional problems result from a multigenerational process in which the level of differentiation becomes lower with each generation

23. Intergenerational Family Therapy Bowen’s Model Goal in Bowen’s model – Increase differentiation – Decrease emotional reactivity to chronic anxiety – Therapist’s level of differentiation will affect therapeutic process – Detriangulation: therapist maintains therapeutic neutrality (differentiation) in order to interrupt a client’s attempt to involve the therapist or someone else in a triangle.

24. Structural Family Therapy The following slides are related to Structural Family Therapy Model

25. Family Systems Therapy in Practice IV Structural Family Therapy (SFT; Salvador Minuchin) – Focus on changing the organizational structure of families – Role of the counselor: Directive – Key concepts Primary focus is to change family structure to better nurture the growth of its members.

26. Key concepts in Structural Family Therapy Map family structure to assist in resolving MH symptoms and relational problems: Assess family functioning in following areas: – Boundaries – Hierarchies – subsystems Restructure family Realign boundaries and hierarchies Promote growth and resolve problems

27. Key concepts in Structural Family Therapy Therapist is active and directive – Stage enactments – Realign chairs – Question and or challenge assumptions in the family – Focus on family strengths

28. Key concepts in Structural Family Therapy Boundaries= rules for managing physical and psychological distance between family members. Boundaries also regulate: – closeness – Distance – hierarchy – family roles.

29. Three types of boundaries Clear boundaries: allow for close emotional contact with others at the same time allow each person to maintain their own identity /differentiation Enmeshed /Diffuse boundaries: diffuse or weak boundaries lead to relational enmeshment (examples: interrupt while others speak, mind read and make assumptions, overprotective, demand loyalty at expense of needs of others, feel threatened if disagree. Disengaged / Rigid boundaries: rigid boundaries lead to relational disengagement. Autonomy and independence are more important than emotional connectedness. (examples: lack of reaction to problems, freedom to do as they please, few demands for loyalty, parallel interactions in the same room.

30. Enactments Enactment: technique in which SFT prompts the family to reenact a conflict or other interaction. Enactment is the best way to handle arguments in the office “Can you reenact what happened in that event you are talking about?” Rearrange chairs physically to increase or decrease emotional closeness Allows family to realize the problem is not just with IP, but with family interactions Minuchin preferred enactments to talking about interactions (people talk one way but interact in another way)

31. Enactments – Assess and alter problems with interactions – Allows therapist to map, track, modify family structure – Assess the boundaries in the enactment – Use enactment to strengthen parental hierarchy and boundaries

32. Restructuring One way to restructure is to reinforce boundaries: – Stop families from interrupting – Don’t allow family members to speak for others Second way to restructure is to increase engagement: – Increase empathy – Encourage eye contact – Help parent manage child’s behavior in session.

33. Overview of SFT Join the family and build a rapport /alliance with family (accommodate to family style, use language of family in how they talk) observe patterns, habits, behaviors of family culture and join the rhythm of the family. (i.e., do they use humor etc) at same time be differentiated. Map the family structure (boundaries, hierarchies) evaluate and assess process and content Intervene to transform the structure to diminish symptoms Therapist has to be flexible and may need to use various roles to move family toward change

34. SFT Assessment Role of symptom in the family Subsystems Cross-generational coalitions Boundaries Hierarchy Complementarity Family development strengths

35. Role of symptom Three possible relationships between the symptoms and the family system – Family as ineffectual challenger of symptom: family is passive and fails to challenge IP – Family as shaper of IP symptoms: the family structure shapes the IP experiences and behaviors – Family as beneficiary of symptoms: the symptom regulates and maintains the family structure – Target family interactions not IP

36. Subsystems Assess subsystems – Couple – Parental – Sibling – (if grandparents in home assess their role) – Hobbies /sports – Interests – personalities

37. Cross-generational coalitions Cross-generational coalitions: a subsystem that forms between a parent and child against the other parent or caretaker – Example: mother overinvolved with children who has unresolved marital or parenting conflicts with the spouse. – Sometimes coalitions are secretive: don’t tell your father…., or I’m glad you are not like your father …….

38. Hierarchy Therapist has to attend to parental hierarchy to know how to intervene: – Effective: appropriate parental hierarchy the parents can set boundaries and limits while maintaining emotional connection with their children – Insufficient: parents are not able to effectively manage the child’s behavior and parents adapt a permissive parenting style. Easy to observe b/c children not behave, not follow rules. Usually enmeshed boundaries with kids – Excessive: rules are strict and unrealistic consequences are too severe to be effective. Rigid boundaries. Help parents develop age appropriate rules and expectations and develop a stronger emotional bond with their kids.

39. Complementary Assess for rigid complementary patterns between family members – Logical/ emotional partner – Strict/ permissive parenting – Over functioning / under functioning – Assess mutually reinforced patterns and target ones that need to change for members to grow

40. Family Development Family is growing and changing in response to predictable stages of development as well as unexpected life events: death, move, divorce – Couple formation – Families with young children – Families with school age or adolescent children – Families with grown children – At each stage members need to renegotiate boundaries to define the levels of closeness and differentiation that will support members’ growth needs – Families get stuck transitioning one stage to other if they fail to renegotiate boundaries and hierarchies as family develops

41. Strengths Don’t label family as dysfunctional Focus of family strength – Ie, their willingness to come to therapy is a strength – Families provide support, protection – Motivated to change

42. SFT Interventions Reframing: remove blame from IP and spread blame equally by describing how each person’s response contributes to the problem dynamic. Example Wife nags---husband withdraws More she nags more he withdraws Highlight the more she pushes him to interact the more he will continue to withdraw

43. SFT Interventions Boundary making: special form of enactment that targets over or underinvolvement to help families soften rigid boundaries or strengthen diffuse boundaries Actively set boundaries allows family to experience underutilized skills and abilities. Examples: – Family change seats – Move seats further or closer together – Turn seats away or toward certain family members – Ask one or more members to remain silent during an interaction – Ask questions that highlight a problem boundary area: do you always answer for your son? – Block interruptions / encourage pauses for others to speak

44. SFT Interventions Challenge the families world view – Verbally question operational assumptions in the family system (overt or implied) – Examples: Kids needs come first Keep the peace / don’t rock the boat Easier to sacrifice my needs than ask for what I want It’s better for the kids for us to stay in this unhappy marriage

45. SFT Interventions Intensity and crisis inductions – Use affect to create structural shifts in hierarchy and boundaries – Typically use this technique with a family who chronically avoid a conflict or problem – i.e., family member who has addiction problem and family avoids, stage a crisis and therapist helps family develop new interaction patterns

46. SFT Interventions Unbalancing – Used when IP is being scapegoated – Used to realign boundaries between subsystems – Therapist joins sides with IP and argue their cause or help explain their perspective – May use this after other interventions have failed

47. SFT Interventions Therapists shape behavior by complimenting family when they move toward their goals and when interactions begin to change Compliment strengths