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

2. 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

3. 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

4. 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

5. 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

6. 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

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

8. 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

9. 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)

10. 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

11. 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”

12. 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

13. 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

14. 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

15. Underlying Conceptual Lens
(Lebow, 2014)
Underlying Conceptual Lens

16. 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

17. 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

18. 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

19. 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

20. 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

21. 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

22. 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

23. 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

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

25. 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

26. 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

27. (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

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

29. 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

30. 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.

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

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

33. 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

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