1. Introduction to Marriage and Family Therapy

2. Case
John called the therapist for his ongoing sexual problems with his wife Melissa. The couple has been married for 3 years and have a 1 year old son. John said to the therapist that their sex life worsened after the birth of their son.
Melissa: If you made me feel loved, I would then have sex with you. But, I feel like you don’t love me and that you have changed.
John: If you look like how you used to and had sex with me, maybe then, it would be easier for me to want to be affectionate towards you. But all you care about is our son.
Melissa: No, that’s not true, and do not talk to me in that tone!
At this point, the room is filled with hostility and anger, and the therapist starts wondering “is it too late to see them each individually?”

3. Background
Family has been left out of the therapy room till 1950s. WHY?
Freud’s psychodynamic therapy
Interested in family as remembered
Mainly focuses on intrapsychic issues
Carl Rogers’ client-centered therapy
Self-actualization

4. Background Developmental Psychology Emphasis on the individual
Strong focus on the individual across the lifespan
Emphasis on the individual
Mental illness is believed to be in the individual’s mind
DSM-IV Diagnostic Manual

5. Why Marriage and Family Therapy?
Dominant forces in our lives are externally located
50% of all problems brought to counselors are related to marriage and family issues
Changing the family structure changes the life of each of its members

6. Shifting the level of analysis
The whole is bigger than the sum of its parts
Seeing the family as more than a collection of its members

7. Why marriage and family therapy?
Individual behavior does not occur in isolation but is embedded in the broader family context
Individual’s symptomatic behavior is seen as an outcome of family interactions and not as the result of individual dynamics.
So, then if John is suffering from depression, how would a individual therapist vs. family therapist look at his depression?

8. Basic principles Family is the entity of focus
Family seeks stability (homoeostasis)
In the face of environmental changes, family changes its structure
Q: what are some of the environmental changes that occur that changes the family?

9. The Evolution of Family Therapy
1950’s
Group of psychiatrists studying schizophrenia: Don Jackson, Gregory Bateson and Jay Hayley at the Mental Health Research Institute in Palo Alto, CA
Murray Bowen at the National Institute of Mental Health

10. The evolution of family therapy
2 main observations were made
When a patient got better, someone else in the family got worse almost as if the family needed someone to be sick – The opposite is also true
Patients often improved in the hospital only to get worse when they went back home

11. Double bind and pseudomutuality
They challenged the idea that schizophrenia is simply a biological disease
Can schizophrenia be a byproduct of communication pathology?
Double binds and communication pathology
Father to son:
“Always stand up for your rights, no matter who, no matter what. AND
“ Never question my authority, I am your father and what I say goes”

12. Characteristics of a Double bind
Two or more persons are in an important relationship
Repeated experience
Overall experience: "I must do it, but I can't do it"

13. Double bind examples Patient put arm around mom
She stiffens but then when he withdraws: “don’t you love me anymore”
He blushes
She says: “You shouldn’t be so easily embarrassed to show your feelings”

14. Double bind examples Teacher to students
“I want you to participate in class”
When there is participation, teacher gets impatient and interrupts them
“Does anyone have questions?”
When no one responds “Students are so passive!”

15. Pseudomutuality For example: In alcoholic families:
An atmosphere maintained by family members in which surface harmony hide deep and destructive intrapsychic and interpersonal conflicts.
The family acts as if it is close and happy when in fact it is not.
For example: In alcoholic families:
Heroes: pick up responsibility, parentified
Scapegoat: Respond to negative environment, they become losers

16. More on Communication Report vs. Command
Every message has a stated content and
How it needs to be done
Metacommunication
Wife yells at husband for doing the dishes
He says he will do it and doesn’t
What is the report? What is the command?

17. More on communication Content vs. Process Wife: “Do the dishes”
Husband: “Don’t tell me what to do?”
Wife: “Maybe if you were more responsible, I wouldn’t have to”
Husband: “I am out of here”

18. Marriage/marital counseling
1930’s First professional centers for marriage counseling were established in LA, NY and Philadelphia.
1948: First publication on marital therapy by Bela Mittleman
She determined that spouses can be treated by same analyst
It is possible to reexamine couples’ irrational perceptions of each other.
The couple's reactions to each other may stem from their relationships with their parents.

19. Marriage/marital counseling
Marriage counseling was absorbed/included into the family therapy movement.
Marriage seen as a subsystem of the family that needs to be treated.
For this course:
Marital therapy family therapy

20. Evolution of MFT
1942: American Association of Marriage and Family Therapy was established.
AAMFT today has more than 27,000 members, 1500 training programs