NCE – Family Therapy Section

NCE – Satir Human Validation Process Model

Who is Virginia Satir?

“The family is the microcosm of the world. By knowing how to heal the family, I know how to heal the world….Peace within, peace between, peace among.” (Metcalf, 2011, p. 175).

Virginia Satir, (1916-1988) is the founder of the Satir system of family therapy. Her humanistic perspective intermingled with a respect for empirical research is what makes her approach interesting (Haber, 2002).   It incorporates a few central insights that appear in opposition to one another at first glance. On one hand, her approach is centered toward increasing self-esteem of individuals (McClendon, 1999, p31). This occurs through attempts to achieve greater congruence between the mind, body and spirit as well as from a greater level of self awareness overall (McClendon, 1999, p31).  On the other hand, against this self-honoring perspective, is one that attempts to understand people in relation to others (Metcalf, 2011). Her utilizes the concept that the whole is greater than its parts (McClendon, 1999).   It’s when you take into consideration her own difficult family background that the underlying reasoning for this dichotomous perspective is seen.  Virginnia Satir hopes to help others understand that we are more than our past histories (Mishlove, 2010a). Her work her work is geared toward helping clients achieve this underlying end goal.

 Satir’s Human Validation Process 

Satir’s Human Validation Process utilizes the concept of emotional validation, a notion closely associated with Linehan’s DBT approach.   It is important, therefore to differentiate this concept from the laymen’s definition of “valid” which pertains to the factual nature of a “thing”.  As Satir uses the term, validation can be thought of as similar to the compassion & empathy – except that goes much deeper.  To understand what I’m talking about, it might help to first discuss the concept of invalidation:

What is Invalidation?

Marsha Linehan (1997), defines invalidation as “trivializing, punishing, judging, or ignoring a persons thoughts and feelings”. In a book I own titled “Compassion” the following example shows what might happen if a child never receives any validation:

“Let us imaging the following: A child grows up and never experienced any validation of thoughts or feelings. He is an emotionally feral child, but lives within a community of other people who ignore validation. His parents have a radical behaviorist approach…adhering to the strictly behavioral position that emotions…are meaningless constructs.” (Gilbert, 2005, 199).

What is Validation?

While invalidation means denying an individual’s experience, validation means finding the grain of truth in the reality of their experiences, even if slightly distorted (Gilbert, 2005).   SHVP, developed by Virginia Satir, reflects this concept of validation. It focuses on how family patterns influence the growth and well being of its members (Metcalf, 2011). For example, this SHVP describes a variety dysfunctional communication styles and open vs. closed family systems (Metcalf, 2011).  This present and experientially -oriented perspecrtive sees individuals as having innate self-actualizing tendencies (Metcalf, 2011). Change, according to Satir, occurs in six stages that are similar to dialectical behavioral therapy (McKay, 2007).   Changes to the status quo of a family can only happen when foreign concepts are introduced into the family dynamic (Linehan, 1997; McKay, et al, 2007; Metcalf 2011).   It is only after a period of chaos and integration, a new status quo emerges (Linehan, 1997; McKay, et al, 2007); Metcalf, 2011).

Theoretical Assumptions

  1. “All humans have the ability to change
  2. humans have internal resources to allow growth throughout life.
  3. Humans are innately good.
  4. Coping is related to a person’s level of self-worth…
  5. Change occurs from experiences and leads to insight….
  6. Healthy relationships are based on equality” (Metcalf, 2011, p. 175-176).

A View of the Family

Metcalf (2011) states that Satir’s approach encourages the therapist to find new ways to view the family by encouraging us to confront our views of it.  For example, multicultural sensitivity is important in this approach. Additionally, this approach recognizes family structures considered by some as “unconventional”.  Human validation is essential with Satir since this allows us to function as a whole person in our relationhips.  Family systems are described here as either closed or open systems.

  1. “Closed Systems represent a troubled family dynamic” (Metcalf, 2011, p. 177). 
  2. “Open Systemsrepresent a nurturing family dynamic” (Metcalf, 2011, p. 177).  

Intriguing Concepts

Eight Universal Internal Resources

Satir, describes eight internal resources within an individual that can be thought of as lays of experience, much like an onion.  Each layer is built from the previous one and are listed as follows: (1) physical, (2) intellectual, (3) emotional, (4) sensual, (5) interactional, (6) nutritional, (7) contextual, & (8) spiritual.

Dual Dialogues.

In her conversation with Jeffrey Mishlove on “Communication and Congruence”, Satir brings up the issue of dual dialogues (Mishlove, 2010a). Essentially, she states that we are continually engaging in two simultaneous dialogues (Mishlove, 2010a). While one dialogue is comprised of our words, the other is regarding our suppressed beliefs and feelings. As a result, what you have is a left-brained narration against a subconscious right-schema, that can be seen throughout our nonverbal communication. What makes this notion particularly intriguing, is how it can be taken into context with her idea of promoting congruence throughout our lives. This happens by coming to owning all elements of our experiences into the present, and relating them to a greater familial dynamic. (Bahmen, 1986).

Four Dysfunctional Communication Styles

Satir states that our experiences and self-perception create motivational forces within us that have a huge impact on our relationships and the sort of communication patterns we utilize.  Satir states that by examiniing the communication patterns within a family we can learn much about the dynamics amongst its’ members.  For example, Satir described the following dysfunctional roles that a therapist can uncover within familal communication styles.

  1. Placatar – avoid and cover up uncomfortable truths
  2. Blamer Feels isolated and then attributes others for feeling this way.
  3. Super-Reasonable – Uses logic to deny or discount stressful emotions
  4. Irrelevant distracter – attempts to deflect stress and may flounder between the first three types

Coping As Cause.

Virginia Satir conceives our preferred coping methods, as developing within a larger familial dynamic that are passed along in a transgenerational manner (Bahmen, 1986). As she has famously noted, “The problem is not the problem; it is the coping that is the problem.” (MCclendon, 1999, p31). What is meant by this exactly?

As Satir explains, our understanding of the problem is based on our coping style. This coping style is a reflection of our self-esteem. In Satir’s conception, self esteem is a matter of congruence between our mental, physical and emotional components (McClendon, 1999, p31). Acceptance and appreciation of our individuality at all these levels is essential for self-esteem (Haber, 2002). So how does this lack of self-esteem result in altered coping?

To explain this, it helps to understand Satir’s reference to systems theory to understand family dynamics. In particular, it is often deficient homeostatic mechanisms within a family that can result in the perpetuation of unhealthy coping styles (McClendon, 1999). In a manner similar to the development of attachment styles, coping styles can also form over time. The underlying goal is to maintain an interactional familiar equilibrium style (McClendon, 1999). Examples of common coping styles in Satir’s coping styles, include placation, blaming, and irreverence, and super-reasonableness (Bageman, 1986).

Disowned Emotions

In the video “Becoming More Fully Human”, (Mishlove, 2010b), Satir mentions the notion of unowned emotions   It appears to be a critical component in her assertion that a congruent self-esteem is essential. Without this, you have an experiential reality that excludes subconsciously certain components. For example, for those who are super-reasonable in their coping style, you see a wealth of emotions, which they prefer to disown (Bageman, 1986). So what are disowned emotions?

As per Satir, disowned emotions are those parts of ourselves that we fail to acknowledge. They are the result of an unhealthy relationship with feelings, in which we think with them rather than through them. Seeing through the eyes of disowned feelings, means our energy between different components of ourselves (McClendon, 1999).   It is for this reason, that bringing our emotional, psychic, and spiritual selves into convergence is so critical to Satir’s theory (Bageman, 1986). They allow for a fuller attendant understanding of present issues.

How Change Counts

Satir describes a six-stage process that begins with an awareness of the nature of the status quo.  In stage two foreign elements are introduced into the family so that change is required if they are to adapt successfully.  As might be expected, stage three begins when the status quo is disrupted and chaos reigns.  People make new choices and forego routine.  Integration involves adapting to new experiences this leads to stage five in which everyone practices new skills.  Finally you have a new status quo…

STATUS QUO >>> FOREIGN ELEMENT >>> CHAOS >>> INTEGRATION >>> PRACTICE >>> NEW STATUS QUO…

People as Icebergs

Virginia Satir believes that people are like icebergs, in that a great majority of their inner experience lies beneath a surface (Metcalf, 2011). For this reason, therapists must uncover the inner aspects of our experience and explore them further. As I understand it, this iceberg concept, is an effective way of describing our emotional baggage. This emotional baggage is a byproduct of our interpretations of various emotional experiences in life. Satir describes these reactions to life experiences as “feelings about feelings” (Metcalf, 2011). Interestingly, Satir’s description reflects another concept from Dialectical Behavioral Therapy involving primary and secondary emotions (McKay, 2007). Essentially these concepts indicate that it is our interpretations of various life experiences that cause us problems. These interpretations are byproducts of family expectations. For example, if you were raised in a culture that encourages stoicism, displays of emotion are often met with discomfort and shame. This might be difficult for an individual with clinical depression. “We also show only those parts we want others to know” (Metcalf, 2011, p. 179)

Strengths & Weaknesses

One key strength of this theory is that it works very well in a diverse set of family situations (Metcalf, 2011). Additionally, Satir’s assertion that the family is a microcosm of the world, provides an interesting perspective. It also reflects my belief, that while the field of psychology can help us understand society, the field of sociology can help us understand us as individuals. The biggest weakness of this theory, is that it is based on the idea that all individuals are innately self-actualizing. The reality, in my experience, is that this is not the case for all individuals living in our diverse world

A Point of Disagreement

In the video on “Communication and Congruence”, Satir makes the following statement “I can see and hear better inside you than you can see and hear in yourself because I’m outside you.” (Mishlove, 2010a). When I heard this statement I was troubled. On the one hand, I do seem to understand what she means by it.   In making this statement, she appears to be referencing to the idea that our realities aren’t as we perceive them. We have to make an allowance for the fact that we might not ever entirely see things as they are.

Still, even if this is what Satir intended by this statement, the author does still have concerns. Specifically, one can’t help but wonder if there is ever a time that a counselor can be entirely 100% confident they understand their clients inner reality. Is it ever possible that we could possibly know their experiences better than they experience them?

Issues Related To Family Therapy

Ethical Issues

The first issue that immediately comes to mind upon discussion of any family counseling are the related ethical concerns. For instance, as a new counselor, how is one to conceive of the notion of family as the client. When you consider the ethical ramifications underlying this idea, it is clear supervision and proper education are vital.   Issues to iron out ethically, when entering into therapy, are any “ground rules” which may govern the underlying process. For example, if information is shared with one family member, how is the counselor to know when to break that confidence? Mandatory reporting laws aside, what about the issue of veracity versus nonmaleficience? How is one to know which ethical principle takes precedence? Knowing the rules of law, with an understanding of the relevant guiding principles underlying these situations is crucial (Corey, et al, 2011).

Family Needs vs. Individual Needs

The other issue, which does appear as vital as well, is how one balances needs of the family against the needs of individuals. An array of specific scenarios in mind could come to mind, in which the well-being of an individual may contradict that of the family (Corey, et al, 2011) How do you weigh the desire to improve family dynamics, against the need to address individual self-esteem?   The answers to this question aren’t obviously clear cut, and therefore require proper supervision, and experience to traverse adeptly.

Satir Human Validation Process

  1. PHASE ONE – JOINING/BUILDING RAPPORT …reaching out…attending…mirroring…observing.  
  2. PHASE TWO – UNDERSTANDING THE PRESENTING ISSUE:  The problems result from how we choose to cope with them. 
  3. PHASE THREE – ASSESSMENT OF FAMILY DYNAMICS: the therapist focuses  perceptions, feelings, expectations, & yearnings.
  4. PHASE FOUR – Therapist is educator teaches client’s new ways of responding and perceiving, responding and communicating in relationships. 
  5. PHASE FIVE – AMPLIFYING CHANGE: as clients experience higher self-esteem, homework assigned to reinforce.  
  6. TERMINATION – In this model, change is ongoing and the work is never completed or finished.

References

Linehan, M. (1997). Validation and psychotherapy. (pp. 353-392). American Psychological Association. doi:  10.1037/10226-016
Gilbert, P. (Ed.). (2005). Compassion: Conceptualizations, research and use in psychotherapy. Routledge
McKay, M., Wood, J. C., & Brantley, J. (2007). The dialectical behavior therapy skills workbook. Oakland: New Harbinger
Metcalf, L, (2011). Marriage and family therapy: A practice oriented approach. New York: Springer Publishing Company
Bahmen, J. (1986). Virginia Satir’s family therapy model. Individual Psychology: The Journal of Alderian Theory, Research, & Practice, 42(4), 480-
Corsini, R. J. & Wedding, W. (2011). Current Psychotherapies. Belmont, CA: Brooks/Cole
Haber, R. (2002). Virginia Satir: An integrated, humanistic approach. Contemporary Family Therapy: An International Journal, 24(1), 23-
Corey, C., Corey, M.S., & Callanan, P. (2011). Issues and Ethics in the Helping Professions (8th Ed.) Belmont, CA: Brooks/Cole.
McClendon, J.A. (1999). The Satir system in action. In Daniel, J. Weiner, (Ed.). Beyond Talk Therapy: Using Movement and Expressive Techniques in Clinical Practice. (pp.29-54). Washington, D.C., U.S.: American Psychological Association.
Mishlove, J. (2010a). Virginia Satir: Communication and Congruence (excerpt). Retrieved From: http://www.youtube.com/watch?v=vfkWnQNWCRE.
Mishlove, J. (2010b). Virginia Satir: Becoming More Fully Human (excerpt). Retrieved From: http://www.youtube.com/watch?v=gW3KShRdKMo

 

 

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NCE – Family Secrets

Overview…

In an old assignment for my family therapy class we discussed Evan Imber=Black’s discussion of secrets.  Imber-Black defines secrets as information which is withheld from someone that produces distress and shame as well as create symptoms of dysfunction in a family. Keeping secrets requires a degree of heightened tension and anxiety. Communication is less open and individuals are less emotionally present. For the secret-keeper a feeling of shame perpetuates the secret and an anxious worry that “if you knew you wouldn’t love me anymore” pervades their thinking (Family Secrets, 2006). In contrast the person unaware of this secret, exists in the family as an outsider within the system. At some level they are aware of this fact and that there is a problem, but they feel they are not supposed to notice. (Family Secrets, 2006). In addition to worry and confusion, individuals left in the dark begin to doubt their own intuitions. Over time, family secrets develop into a systemic problems that affect many generations. Imber-Black (Family Secrets, 2006), describes relationships as booby-trapped, waiting to explode symptomatically as a result of the ongoing secrecy. Triangles, betrayal, and hidden-alliances as just a few symptoms of secrecy in families that can develop over time (Family Secrets, 2006). In the end, nobody is able to live as a whole individual in full acknowledgment of the truth (Family Secrets, 2006). In time boundaries are laid down in which those who know and don’t know become divided (Family Secrets, 2006). Symptoms of these secrets are maintained and supported by efforts as by family members to maintain secrecy for the sake of a systemic homeostasis.

Secrets Supporting Symptoms

Imber-Black states that “knowing, but acting like you don’t know and pretending you are what you are not” are key components of secret keeping (Family Secrets, 2006). With this in mind, what exactly is meant by Imber-Black’s assertion that “secrets support symptoms” (Family Secrets, 2006)? The maintenance of family secrets requires a concerted and coordinated effort by everyone in the family. These efforts can involve the closed communication systems, rigid boundaries and emotional distance. By keeping a secret, the family is able to maintain homeostasis, although change is unable to happen for the better. For this reason, I am in agreement with Imber-Black’s therapeutic stance regarding the Reiger family secrets. While Imber-Black is supportive of whatever decision the family makes, and allows them to move at their own pace, she makes her position clear (Family Secrets, 2006). Secrets restrict the free flow of information, harming everyone involved. The secret keeper, is left with distress and shame and unable to live life outside this reality (Family Secrets, 2006). At the same time, this secret violates a person’s right to know, and “affects their ability to freely [process all information] about their lives” (Family Secrets, 2006)

Understanding The Positive Outcome

​What factors attributed to a positive outcome in this particular case? Not all instances of revealing family secrets, are likely to go as well as they did within the Reiger family. Fortunately several important factors were working in their favor. Firstly, I feel it helps that Dr. Imber-Black was the therapist. As an individual who has studied, written, and researched extensively on this issue, she was able to delineate several symptoms of family secrecy in the video. Additionally, I do feel it helps that some time has pasted since the tragic circumstances of Jerry’s death. The emotions surrounding these events are a bit “less raw”. I also think the strength of Ray and Liz’s marriage helped them work through this issue together. They appeared willing to listen and support each other throughout this process. Finally, while Liz’s parents and Jerry’s family had strong opinions about their marriage at the time, fortunately they were able to move past these issues. It seems they were open-minded enough to see things from Galen’s viewpoint, and how this secrecy was a dis-service to him.
​In cases where things do not go very well, I would expect to see a family divided, as a result of this new information. The mourning of a lost relationship is strangely similar to a death “of sorts” as family members stopped communicating. The end result is a long process of “radical acceptance” and “forgiveness” in order to begin moving forward. The toughest thing in such cases is the realization that you can only have control over your own actions and behavior.

References

Family Secrets: Implications for Theory and Therapy [Video file]. (2006). ​Psychotherapy.net. Retrieved October 15, 2015, from The Psychotherapy.net Collection.
Imber-Black, E. (1999). The Secret Life of Families: Making Decisions about Secrets: ​when Keeping Secrets Can Harm You, when Keeping Secrets Can Heal You–and ​how to Know the Difference. Bantam Dell Publishing Group.

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NCE – Narrative Family Therapy

What are stories?

A favorite self-help guru of mine is a narrative therapist.  Narrative therapy focuses on how we live our lives through a storied perspective.  events in our life are linked together into a plot that is imbued with a meaning and/or purpose.  The story reflects the meaning we give our life and the socially relevant manner in which we interpret.  How we tell the story and create it is the subject of therapy.  what have we edited out?  How is our live story constricted by a narrowed perspective.  what can be done to re-author it?  “Changing the language you use to describe experience can bring about new meanings that lead to meaningful action toward transformation” (Metcalf, 2011, p. 332).

What is Narrative Therapy?

Also referred to as “reauthoring therapy”, (Metcalf, 2011, p. 332), narrative therapy asserts that change happens by altering the meanings we give life experiences.  Our perceptions influence our interactions and behaviors.  The Narrative therapist assists clients to resolve their problems by helping them to separate themselves from the problems that keep them from a fulfilling life….They can reauthor their life with the narrative metaphor as a guide throughout the process.

Theoretical Assumption

  1. “Our lives are socially constructed” (Metcalf, 2011, p. 333)
  2. We organize our lives through stories – this leads to a narrated plotline” (Metcalf, 2011, p. 333)
  3.  The dominant discourse in our society powerfully influences what gets storied and how it gets storied” (Metcalf, 2011, p. 333)
  4. “Locating problems in discourses help us see people as separate from their problems” (Metcalf, 2011, p. 333)

Interventions

  1. Externalizing Conversations – see the problem as separate from the self by not identifying with it.
  2. Deconstruction – Examining your perceptions as something that defines experiences.
  3. Internalizing Questions – each  asks questions while the other listens without responding” (Metcalf, 2011, p. 334).
  4. Unique Outcomes – divergent outlier experiences that do not coincide with the story we tell.
  5. Reauthoring – giving a lie experience new meaning. 
  6. Letter writing, definitional ceremonies

working Template

  1. Change – What does the voice of (your problem) tell you and how does this influence daily life?” (Metcalf, 2011, p. 338)
  2. “Rapport – You’re deciding if you’d like to open up your life to me. Are there things about me that its important for you to know?” (Metcalf, 2011, p. 338)
  3. “Presenting Issue – What are your expectations for yourself when the (problem intrudes your life?” (Metcalf, 2011, p. 339).
  4. Assessment of Dynamics: “So your view of yourself as a victim has harnessed you into isolating yourself from people…”(Metcalf, 2011, p. 339).
  5. Goals – “what would you call this thing that you’re struggling against?” (Metcalf, 2011, p. 339).
  6. Amplifying change – “As we work together to change the course of the problem, who can help to sustain the preferred story or identity?” (Metcalf, 2011, p. 340).
    g. Termination? – “What was most helpful?” (Metcalf, 2011, p. 340).

References

Metcalf, L, (2011). Marriage and family therapy: A practice oriented approach. New York: Springer Publishing Company

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NCE – Emotionally Focused Family Therapy

​Emotionally Focused Therapy (EFT) is an approach based on insights from attachment theory and focuses on how personal inter-relational patterns regulate our emotions and interactions with others (Metcalf, 2011). Understanding the preconceived notions one holds in relation to others can illuminate why repetitive relationship patterns keep occurring. The EFT therapist acts as a consultant whose creates a collaborate alliance with couples in order to create a secure relationships (Metcalf, 2011). According to EFT, problems occur when interactional patterns are based on unresolved negative experiences from our past. Metcalf, (2011), notes that these patterns can often develop into an endless feedback loop in relationship. For change to happen, families and couples need to restructure their interactional patterns. This requires a safe and trusting environment in which one everyone can begin understanding the nature of current interactional patterns.

Goals of Theory…

This theory is based on the work of Bowlby who examined childhood attachments and emotional issues with loss of a primary caregiver’s nurturing presence.  As a result of our early attachment experiences, we develop patterns of interaction throughout our lives.  It’s goals are to help client explore their feelings of hurt/longing etc to see how they play out in relationships. The ultimate goal is to help clients develop secure attachments.  The real focus is the inner psychological world of each partners through their interactions.

  1. Therapist is a consultant collaborating with couples.
  2. Emotions are the key element in relationships
  3. Problems occur when interaction patterns based on negative emotions from past.
  4. Change occurs when new emotional experiences are present in relationships.

Three Main tasks…

Metcalf, 2011, p. 344

How Change Happens –

Change happens when the family is able to restructure their interactions so that affiliation and autonomy are both accepted & nurtured in the relationship,,,Focusing on the interaction processes instead of the content of discussion, allows the therapist to work on the patterns that support problems and change them…Change is promoted by altering everyone’s the awareness of what is being communicated and what is needed…..(Metcalf, 2011, p. 345)

One Concept: De-Escalation

Metcalf (2011) briefly mentions the concept of de-escalation as an essential task for EFT therapists. It involves the creation of a safe environment in which everyone is able to openly explore his or her thoughts and feelings. This de-escalation process involves four steps. In the first several steps, conflicts and negative interaction cycles are discussed and identified (Metcalf, 2011). The third step involves addressing the unacknowledged emotions, which underlie these interactional patterns (Metcalf, 2011). With this information in mind, each individual attachment-related needs can be discussed. In the final step, the therapist can assist families and couples in developing a more holistic understanding of the ongoing cycle of conflict (Metcalf, 2011).

Strengths & Weaknesses

Strengths of EFT include its interventional techniques, which appear to be based on empathy and respect. I also appreciated that the EFT therapist holds a collaborative role, which respects the client’s experiences. This would naturally result in a goals that are based on the client’s needs and desires, not just the therapist’s clinical impression. As for the weaknesses, I can’t really see anything about EFT that I disliked. At the same time, I remember vaguely reading somewhere in this class that all empirically sound theoretical perspectives utilize pragmatic solutions-based interventions. In other words, insight-based interventions are inadequate when utilized alone. Having said this, I’m not too familiar with this theory so I could be wrong.

References

Metcalf, L, (2011). Marriage and family therapy: A practice oriented approach. New York: Springer Publishing Company

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NCE – Symbolic Experimental Family Therapy

According to Metcalf, (2011) Symbolic Experimental Family Therapy “Focuses on here-and-now experiences, playfulness, humor, intuition, craziness, spontaneity, and personal growth. It is a pragmatic, atheoretical method for treating families. Incorporates growth of the therapist and clients as the ultimate motivation, and focuses on circular, recursive patterns in a family that lead to mutual benefit and interpersonal context” (p147). Another unique aspect about this theory is that it normalizes pathology.  As I see it, this theory focuses on familial cultures, (i.e. shared meanings, beliefs, thoughts, symbols, and perspectives).  Entering in the “family’s symbolic world” (Metcalf, 2011, p. 148) is the goal here since change is conceived to result from the therapeutic process.

Founder – Carl Whitaker

Stages of Therapy

Symbolic Experimental Therapy is focused on the present.  The  first of therapy begins with the clients’ first contact with the therapist.  It is at this stage, that the therapist is “responsible for setting the tone of therapy.” (Metcalf, 2011, p. 149).   Whitaker, describes the therapist as a foster mother/investigator since, at this point, family morale and information gathering are the focus (Metcalf, 2011). Once therapy has been initiated, it is the family’s responsibility to “take charge of their own experiences…[in an] anything goes  [manner]” (Metcalf, 2011, p. 149).  Interestingly, during the early stages, the therapist is a disconnected observer who, while “joined with the family”, (Metcalf, 2011, p. 149), steps back and lets the family play out their own shared reality.  However, as therapy progresses the therapist pushes the family to address the symbols and meaning that underlies their pain.  This allows them to develop a new perspective upon which to understand their shared experience.  During the termination phase, the therapist begins to disengage as the family learns to adapt to new positive shared experiences.

View of the client

This perspective seems to focus on the shared symbolic meanings that underlie shared family dynamics.   Change happens by understanding the symbolic meanings that give rise to these family dynamics.  Change can happen if the client is willing to work with it.  Within each pathological dynamic is an opportunity for growth, therefore it is conceived as evidence of potential and not malady.  Individual human choices can be contextualized within a shared familial reality since it is from here that we develop our beliefs, values, and cultural identity.   “Families should preserve, protect, and maintain a sense of self while understanding how their being/growth influenced by family history (Metcalf, 2011, p. 150).”

Assumption about marriage

  1. “Marriage is a third entity. In therapy, the clients are the husband, wife and the marriage.
  2. Marriage is greater than the sum of its parts.
  3. People choose partners on the basis of set core beliefs and values
  4. Marriage is legally and emotionally binding. A marriage constrains two persons from getting emotionally involved with other people outside the marriage.
  5. Marriage must learn to grow and resolve unexpected and predictable impasses that occur occasionally. (Metcalf, 2011, p. 151)”

How Change Happens.

Change can happen simply by examining how we choose to interpret our shared experiences.  “Failure is one’s only teacher; success allows one’ the courage to fail.  [Change happens through]personal growth, symbol relief, character development, resolution of dependency, ability to experience emotion/anxiety, & increased spontaneity/creativity (Metcalf, 2011, p. 152).

Basic skills of a therapist

  1. “Able to tolerate pain, anxiety, etc in his own life
  2. Understructure of caring
  3. Able to listen to personal intuition
  4. Ability to become family’s foster parenting and balance nurturing with toughness during therapy
  5. Belief in continuous personal growth…
  6. Ability to interweave beliefs, assumptions, and biases into therapy.” (Metcalf, 2011, p. 152)

Key Concepts

  1. SYMBOLS:  comprise an unspoken underlying meaning that defines our experience.  It gives the meaning to the pain we experience and the options available to us for change and growth.
  2. CRAZINESS:  “allows a person to not be constrained by socially accepted realities, and be more spontaneous and symbolic.” (Metcalf, 2011, p 156).  There are three types of crazy: (1) driven crazy (2) going crazy & (3) acting crazy.  Driven crazy refers to being repelled from intimacy.  Going crazy refers to an intense and neurotic distress.  Acting crazy is a technique that involves regressing into crazy behavior during periods of heightened stress/anxiety.
  3. SPONTANIETY – “rooted in intuition and the use of craziness. Is an unconscious process. Is a key aspect for any personal interaction in therapy…..” (Metcalf, 2011, p 156)
  4. CONFUSION – “Confusion is a symbolic way to open up the infrastructure of the family and disrupting old patterns.”  (Metcalf, 2011, p 156).
  5. FANTASY –  “a form of play that allows the therapist and family to address their separate symbolic worlds & meanings.”  (Metcalf, 2011, p 156)
  6. GROWTH – “growth is the ultimate motivation of thus approach to family therapy. Growth occurs thru play” (Metcalf, 2011, p. 156).

A working template

Change happens by reshaping the “symbols and language used by the family[this provides a]  corrective experience for the family when discussed openly” (Metcalf, 2011, p. 157).  Essentially, this section of Metcalf’s (2011) discussion provides a reiteration of the therapy stages except in terms of the therapist’s objectives….

  1. PHASE ONE  – Build Rapport by upholding a foster parent role by stepping back and observing while relating “to the family as a peer” (Metcalf,2011, p. 157).
  2. PHASE TWO – Once rapport has been established it is possible to begin investigating the problem.  This happens by interviewing each family member without interruption individually.
  3. PHASE THREE:  The next step involves assessing the family dynamics and their desire for change.  “The goal is to understand the past symbols underlying the family’s pain” (Metcalf, 2011,p. p157)
  4. PHASE FOUR:  Develop familial goals.
  5. PHASE FIVE:  Amplifying change by  “getting into a family and then out as soon as possible is the goal, so you don’t leave any marks of your presence behind.” (Metcalf, 2011,p. p157)
  6. PHASE SIX: Termination.

References

Linehan, M. (1997). Validation and psychotherapy. (pp. 353-392). American Psychological Association. doi: 10.1037/10226-016
Gilbert, P. (Ed.). (2005). Compassion: Conceptualizations, research and use in psychotherapy. Routledge
McKay, M., Wood, J. C., & Brantley, J. (2007). The dialectical behavior therapy skills ​workbook. Oakland: New Harbinger.
Metcalf, L, (2011). Marriage and family therapy: A practice oriented approach. New York: Springer Publishing Company

 

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NCE – Strategic Family Therapy

Based on the work of Milton Erickson & Jay Haley, this pragmatic model is more focused on problem solving than insight (Metcalf, 2011). According to this theory, problems develop due to an unbalanced hierarchical structure and dysfunctional communication patterns. The therapist’s role is to observe these patterns in the family, and develop a strategy to address them. It is a directive therapy that isn’t as concerned with how one defines the problem as much as it is with the fact that you’re taking some sort of action to resolve things.  Metcalf, (2011) states that family therapists should focus on “the purpose of the problem” (p. 272).  Action is the key to change, not insight.

Definition of the Problem

According to “SFT” communication in families always comprises a “command message” (Metcalf, 2011, p. 276), defined as unspoken and implied rules of conduct and interaction.  These family rules can be observed in patterns of interaction and behavior by a therapist.  The purpose of this rules is to main an interactional homeostasis.  The term “feedback loops” (Metcalf, 2011, p. 276), refers to stimuli and response interactions that are frequently observed.  As you might expect positive feedback loops create a problem and negative ones solve it.  In therapy, the key to solving problems is to first address the aforementioned rules that define the family’s interactions.  By focusing and defining on the problem and the factors related to it, the family can become motivated to change.  “Strategic family therapists believe that to change family organizational patterns and therefore alleviate the identified problem, the routine in which the clients communicate with one another must be altered.” (Metcalf, 2011, p. 277).

Theoretical Assumptions

SFT aims to solve the problems in the family and alter the underlying structure that produces it.  Many concepts from systems theory can be found in SFT.  For example, homeostasis describes the tendency of a family to maintain the status quo.  The butterfly effect describes the tendency of small changes to produces tremendous ones.   SFT also uses the concept of triangulation in which the tension between two family members is the byproduct of a third one.

How Change Happens

There are two types of change in SFT.  “First-order changes occur when family members attempt to solve a problem repeatedly with the same solution only by increasing the level of intensity” (Metcalf, 2011, p. 280).  Second order change occurs when the family system can shift into a new homeostasis by altering the rules in the family (Metcalf, 2011).

One Concept: Directives

​As a directive and pragmatic therapy model, SFT utilizes directives that are helpful in redefining the rules, structure and boundaries in a family (Metcalf, 2011). The goal of these directives is to motivate clients to modify the interactional patterns which underlie ongoing problems. Two types of directives are described in our textbook: (1) straightforward directives and (2) indirect directives (Metcalf, 2011). Straightforward directives are utilized when the therapist lays out his instructions for helping the family modify their existing interaction patterns (Metcalf, 2011). In contrast, indirect directives utilize metaphor and paradox to provide motivation for change (Metcalf, 2011). For example, paradox directives involve instructing clients to engage in more of the very behaviors that cause problems. This creates a double-bind situation in which change becomes more attractive than inaction (Metcalf, 2011). Ordeal interventions, a slight variant paradox directives, are also utilized by SFT. They involve imposing significant changes that are much more extreme than the desired transformations. This is thought to make those needed transformations much more attractive to the client.

Strengths & Weaknesses

​Benefits of SFT are its pragmatic nature, and tendency to provide a positive spin on problems, not based psychopathology. Despite these benefits, there are several concerns I have about this theory. In fact, I was not surprised to learn that SFT is not a popular model of therapy (Metcalf, 2011). Criticisms of this approach include the manipulative nature of its interventions, and a failure encourage the careful examine underlying issues (Metcalf, 2011). Paradox directives provide just one of many manipulative interventions utilized by SFT.
I also had concerns about how SFT conceptualizes the nature of helplessness (Metcalf, 2011, p262). In keeping with this pragmatic approach, SFT is not concerned with how the therapist conceptualizes evidence of helplessness (Metcalf, 2011). The only thing that appears to matter, is how the therapist’s conceptualization of problems, guides their manipulative strategies (Metcalf, 2011). Finally, I feel the textbook’s discussion of helplessness on page 262, reflects an attitude of blame (Metcalf, 2011, p262). In my opinion, it is wrong to blame a client for a symptoms of learned helplessness.

Working Template

  1. Building rapport – greet family, point out successes/strengths.
  2. Understanding the Presenting Issue – Work towards an agreed-upon understanding of the problem
  3. Assess Family Dynamics – Focus on problem now not their origins.
  4. Developing Goals – Negotiation of goals with family members
  5. Amplify Change – don’t take credit for change, and remain neutral in how chance occurs since this promotes lasting change.

References

Metcalf, L, (2011). Marriage and family therapy: A practice oriented approach. New York: Springer Publishing Company

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NCE – Contextual Family Therapy

Definition of Contextual Family Therapy (CFT)

​Developed by Ivan Boszormenyl-Nagy

Nagy was interested in being over knowing (Metcalf, 2011) and believed people cannot be understood in isolation.   He was interested in examining  individual relational patterns and needs.  Understanding the meaning we place upon our relationships is vital.

CFT is integrative, intergenerational, and multilayered (Metcalf, 2011, p65).

It is integrates perspectives of biology, psychology and sociology, seeks to understand the influence of several generations, and is partial to all family members’ perspectives (Metcalf, 2011). CFT is unique because it focuses on an inter-dimensional relational reality, comprised of multiple perspectives. For example, while our factual reality consists of the logical consequences of our lives that are unchanging. Against these objective realities are the individual’s interpretations of information of experiences into their subjective viewpoint. Finally relationships provide communication patterns and relational balances of give and take that define our day-to-day experiences. According to CFT, it is the therapist’s job to understand these multiple realities by validating and honoring the grain of truth in each viewpoint. In CFT, this is called “multi-directed partiality” (Metcalf, 2011).

  1. INTEGRATIVE – embraces biology, psychology, transactional patters, and responsibility.
  2. INTERGENERATIONAL – seeks understanding of an individual in the family context of at least three generations.
  3. MULTILAYERED – apparent in the therapist’s attempt to understand and be partial to all people who are affected by the discussions in therapy sessions.

​The uniqueness of CFT can be found in its multidimensional perspective of the family, which seeks the grains of truth in each viewpoint. Combining the insights of each perspective is essential in CFT to restore trust and re-establish a sense of balance and fairness.

Key concepts

​Relational Ethics

Metcalf, (2011), describes relational ethics as a unique concept in CFT that “distinguishes [it] from any other approach” (p70). While a laymen’s perspective of ethic refers to a moral standard of right versus wrong, ethics in CFT refers to a balance of give versus take (Metcalf, 2011). As I understand it, this concept acknowledges the fact that we do not exist in a vacuum. Instead our reality and very being is defined in relation to significant others in our lives. Understanding the concept of relational ethics to me may mean that the greatest character statement of who we are is found in the lasting impact we make upon those around us. It also means understanding that happiness can be found as a result of a healthy balance between our own individual needs with those of significant others in our lives. Attending to both are equally critical.

Ledger of Merits

Nagy believed relationships were built on a give-and-take.  Abstract ledgers of indebtedness bs entitlement exist in families.  For example, I believe as a mother, there is a specific indebtedness I have to my children, (i.e. unconditional love, happy memories, a stable home environment, food, clothing, shelter, and education).  I, in turn, am entitled to some respect as their mom.    This ledger of entitlement can include a psychological legacy in the form of  attitudes of destructive entitlement, (discussed next).

Entitlement

Nagy felt individuals had rights that belonged to them  (i.e, enjoy life, creativity and courage of commitment).  This concept of entitlement is not simply a feeling or idea but an ethical construct of fairness that guides our relationships.   As an ethical construct guiding relationships, it can provide a measuring stick against which a relational give and take can occur.  Internally, it can result in a feeling of entitlement.

Constructive entitlement can occur when family members receive respect, acknowledgement, and reciprocation.  We earn construction entitlement by being aware of others feelings and acting on this awareness.  In this respect, it is a reflection of our capacity for empathy.   It becomes destructive when there is no appreciation for the feeling of others, a attitude of over-entitlement, and an absence of give and take.  Situations such as these can become highly abusive.  Nagy used the term “revolving slate” to deceive how attitudes of destructive entitlement can be passed down from generation to generation, (Metcalf, 2011).

Loyalty

Loyalty is an thical concept of obligation to another person, in close relationships. It involved accepting these obligations in relatedness, sharing power, (i.e. give & take).  “Split loyalty – occurs when a person is forced to be more loyal or more disloyal to significant people in his/her life.” (Metcalf, 2011).

Parentification

Parentification can be thought of as a misuse of parental authority.  Englehardt (2012) states:  “The term “parentification” was first utilized in depth by Boszormenyi-Nagy and Spark (1973) to describe a common component of relationships whereby parental characteristics are projected onto an individual. Within the parent-child relationship, this process is often seen when the child performs chores or occasionally offers emotional support for a parent, and is believed to be healthy for the child as he or she begins to see the potential for him or herself in an adult role (Boszormenyi-Nagy & Spark, 1973). However, when the responsibilities become too burdensome, or when the child feels obligated to take on the adult position in order to maintain a balance in the family system” (p. 45).

Four Dimensions of Reality.

Contextual therapy assumes that the key dynamic of any relationship is trustworthi- ness, which is achieved by all family members having mutual consideration of each other (Boszormenyi-Nagy & Krasner, 1980). It also assumes that accountability and fairness are the essential connecting powers in the relational association” (Metcalf, 2011, p. 68).  Nagy uses the term contextual to refer to an ethical guidelines that influence our relational patterns.  These ethical guidelines reflect what Nagy calls “four dimensions of reality” (Metcalf, 2011, p. 68).

  1. “FACTUAL REALITY (DESTINY) – facts of life that are difficult to change including biological facts (i.e. age or sex), medical conditions, historical facts, racial, cultural or personal information” (Metcalf, 2011, p. 69).
  2. “INDIVIDUAL PSYCHOLOGY (NEEDS) – This dimension describes how people transform information from their external environment into cognitive information, experiences, emotions, feelings, motivations and memories. This contextual information can be described as their personality according to this theory.  Whereas facts objective, this is subjective” (Metcalf, 2911, p. 69).
  3. SYSTEMIC INTERACTIONS (POWER ALIGNMENTS) – this context deals with communication patterns in relationships.” (Metcalf, 2011, p. 70).  Family rules exist to maintain a sense of homeostasis…
  4. RELATIONAL ETHICS – “deals with the balance of what people give and what they are entitled to receive from others. Boszormenyi-Nagy (1987) described this process as follows: To the extent that I bene t from your contribution, I become indebted to you and you obtain entitlement on the merit side of your “ledger.” Then when I contribute to you or at least acknowledge your credit, I begin to restore the merit balance. (p. 207)” (Metcalf, 2011, p. 70).

Strengths & Weaknesses

A key strength of this perspective is its multidimensional nature. The multidimensionality of CFT is unique in that it appears to blend multiple perspectives and a relational reality [which is] combines often-divergent needs and motivations (Metcalf, 2011). A weakness of CFT can result from how effective the therapist is at communicating a multi-directive partiality. This concept appears to be a perspective that appreciates the validity in everybody’s viewpoint. In this respect, Metcalf, (2011), makes a point of noting that CFT is not neutral. Depending upon the skill level or contextual relevance of this theory a miscommunication of this concept can occur. For example, without multicultural sensitivity, miscommunication can occur in families with cultures divergent from the westernized perspective familiar to most of us.

Theoretical Assumptions

Nagy believed that people “are who they are” (Metcalf, 2011, p. 71).  For this reason he preferred to reserve judgment & instead assess the relational reality of his client’s.  In “CFT”, change occurs by examining the relational ethical concepts that guide familial interacting spontaneous motivations (see concepts above).  “Through [a] process of multidirected partiality, the therapist empathizes and gives credit to each family member, even if the credits may not be obvious at the beginning. This particular stance allows the therapist to open the dialogue among family members, which is based on responsibility, and encourages the family members to reinvest in trustworthiness” (Metcalf, 2011, p. 71).

A working template…

  1. “PHASE ONE – JOINING AND RAPPORT “What concerns brought you to this session?” What was it like growing up in your family?” (Metcalf, 2011, p. 74).
  2. “PHASE TWO – UNDERSTANDING PRESENTING ISSUE –  “I would like to hear your side of the story about what happened….What are the meanings given to these events?” (Metcalf, 2011, p. 75).  Use multi-directed partiality questions….”I am beginning to sense that in your family your father was HOH and you saw that it troubled your mother. Can you tell me what your view is today? ( Metcalf, 2012, p. 75).
  3. “PHASE THREE – ASSESSMENT OF FAMILY DYNAMICS – family should assess the fairness of their actions, not the therapists. “How did you know that you were loved in your family? How do you think about what your parents did as caretakers?” ( Metcalf, 2012, p. 75).
  4. “PHASE FOUR – GOALS increase trust and exoneration, hold all accountable. “what would it take for there to be more fairness..how will you begin to show your parents that you want things different?” (Metcalf, 2012, p. 75).
  5. PHASE FIVE – AMPLIFYING CHANGE “When the family members begin to recognize the change that they want in themselves and start doing things differently, it can be said that the goal has been met. Here are some comments or questions that a therapist might use during this ph ‘have noticed you’re making real progress.’” (Metcalf, 2011, p. 76).
  6. PHASE SIX – TERMINATION – a mutual decision..

References

Englehardt, J. A. (2012) The Developmental Implications of Parentification: Effects on Childhood Attachment.  Graduate Student Journal of Psychology. Vol 14, (pp. 45-53).
Metcalf, L, (2011). Marriage and family therapy: A practice oriented approach. New
​York: Springer Publishing Company

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NCE – A family genogram

What are Genograms?

Genograms are diagnostic tools which therapist’s utilize to create a multidimensional illustration of family relationship patterns (Galvin, 2015; Metcalf, 2011). They help the therapist understand relationship patterns and the underlying history of presenting problems. While similar to family trees in many respects since they both provide a visual depiction of family relationships. What makes genograms unique, are they also depict the nature and quality of family relationship patterns across time (Galvin, 2015a).

How would you use a Genogram?

​Gavin, (2015a) states that the Genogram is intended to reflect an individual’s point-of-view of a family’s psychosocial history at a specific point in time. Therapists often utilize several sessions to explore each family member’s understanding of the family’s relationship history (Galvin, 2015a). It would be interesting to compare and analyze these results from all family members in order to uncover varied beliefs and perceptions of family roles and communication patterns. The process of creating a series of genograms can provide an opportunity to discuss family history in detail. This could facilitate an exploration of disagreements in order to multiple sides of an issue from a historical perspective. While my sister and I have never undergone a genogram like this our perspectives of the family are very different. I have personally found a synthesis of these divergent viewpoints very illuminating.

Issues Addressed in a Genogram?

Symbols utilized to create a genogram depict the marital status of couple relationships as well as any children created from the union (whether living or deceased) (Galvin, 2015c). Unlike the family tree, genograms also depict other qualities such as the degree of closeness, hostility, and abuse histories, and relationship triangles (Galvin, 2015c).
Taking time to analyze these results in detail also provides an array of more in-depth information according to Galvin, (2015b). For example, a close examination of dates shed light on the family’s response to key events. Cultural beliefs, as well as trends and patterns regarding boundaries and family structure also exist upon close examination of results (Galvin, 2015b). Finally, comparing results between family members can expose family secrets (Galvin, 2015b).

A Look @ My Own Familial Genogram

While this project was definitely a challenge technologically, it was also educational. I’m fairly happy with the outcome, although I noticed one minor mistake. I forgot to put the male parent on the left (Metcalf, 2011, p14). While I wasn’t able to make these changes to the attached photos, a corrected version of my genogram was emailed to the instructor with a registration key for viewing.

Sources of Information

My primary sources of information were my parents and sister. My grandparents are all deceased, and my mother’s family lives in the Philippines. Due time-zone differences, calling them wasn’t possible. I am also not very close to my father’s family and have not decided to contact them for this assignment. My husband’s portion of the family tree, was from his own memory. He isn’t very close to siblings and his parents are both deceased.

Key Insights

While I was unsure of whether or not it was necessary to include my husband’s family tree, I decided to do so, only because his family background differs so greatly from mine. It provided an opportunity to understand the ripple effect of family history on development and growth (Metcalf, 2011). In addition to a history of abuse and addiction, there are quite a few divorces throughout my husband’s family tree. In contrast, my family background included no history abuse or drug addiction or abuse. However, a huge cultural gap between my paternal and maternal relatives was quite problematic for me. I attribute this cultural gap to an misunderstanding between my maternal grandmother and mom. Additionally, this factor can explain in part why I was never close to my maternal cousins. I discuss this further below:

Genogram for My Maternal Side

Acquiring information for my mother’s family was especially challenging because much of the information we require predates World War 2. Few records are still existing from this time period due to widespread loss resulting from the war. The time zone differential also made contacting my mother’s family problematic. Several key insights can be noted when viewing this side of family tree.

  1. My mother is closer to her maternal sister: My mother says she rarely had an opportunity to meet her father’s family. However, after World War 2, her four aunts and uncles lived nearby and she grew to know her mother’s extended family well. Without asking my grandparents, it is impossible to know the reason for this.
  2. My mother has a distant relationship to her sister: My mom and her sister both came to the United States in the 1960’s in order to complete medical school. While it was never their intention to stay here, they ended up marrying and settling down in the States. Despite the fact they live in the same country, they rarely speak. While they deny animosity, I am uncertain as to the reason for this. My mother is unwilling to elaborate.
  3. I feel a closer relationship with my maternal grandparents – Culturally, the Philippines is collectivist in its orientation and life centers around family. My mother has explained that a sense of love and connection comes through honoring your “duty”. This notion involves committing a significant portion of your identity and life’s purpose to your role within the family. In the individualistic society we live in, this is a foreign notion. As a byproduct of this cultural difference, I was always closer to my maternal grandparents. I felt they took it upon their selves to fulfill a role as grandparents and were aware of how important this role was. I came to understand all their actions and words as reflecting a sense of duty, which I understood as an expression of their love.
  4. The women in my mother’s family are all well educated: As the story goes, my maternal great-grandmother (Dorotea Santiago-Gonzales) was an only daughter with several older brothers. Her family put the sons through college but not their daughter. T his angered her, and she determined all her daughters would get an education. Consequently, her daughter Maria became a teacher, Guadelupe a Chemist/Business owner, and Consuelo, an M.D. Her oldest daughter, Maria, carried this tradition further, and put her two daughters (my mother and aunt) through medical school.

Genogram for My Paternal Side

Similarities between my mother and father’s family include well-educated individuals who appear to enjoy long-lasting marriages. However, key differences, in a culture gap and divergent perspectives on a women’s proper role in the family. What follows are a few key insights from this side of my family tree.

  1. My paternal grandmother (Charlotte) did not get along with my mom: My grandmother Charlotte was a stay-at-home mother. She was a byproduct of the “Leave-it-to-Beaver” era, and believed a woman’s place was in the home. My paternal grandmother never got along very well with my mother, and often made snide remarks about the fact that she worked. When I asked my mother about this, she downplayed the severity of things, although I notice she was often uncomfortable around the holidays. I think the fact that my mother is Catholic and my grandmother Charlotte was atheist didn’t help matters either.
  2. I never felt comfortable around my cousins and was never close to them: In my immediate family, my mother was the disciplinarian. My father preferred to allow her to take the lead in this respect. As a result, I was raised according to my mother’s cultural beliefs. My mother discouraged me from dating until college. I was much more naïve and inexperienced in this particular area than a typical woman of your age. Additionally, my mother made me dress conservatively and preferred me to not wear any makeup until college. Finally, in keeping with her culture, I was to always show my mother respect. These character traits made me very different from my cousins. I had two female cousins the same age as me, and I was the oddball. They were your typical rebellious American teenagers. They wore makeup and the latest most fashionable clothes. I was a naïve tomboy that always listened to her mother. Fitting in was difficulty for this reason.
  3. My father is very close to his brother Ted and has a distant relationship with Mike: My father has one brother who is about 15 months older who is still very close with. In contrast his youngest brother, Mike, is 18 years younger. They are not really very close, since my father was out of the house by the time Mike was born.

My Husband’s Family Tree

My husband’s genogram is reflective of a greater degree of turmoil, in comparison to my own. While this family background has been the source of much pain, my husband has endured these experiences to become an amazing and thoughtful husband/father. Key insights reflected in my husband’s family include the following:

  1. My husband’s Father was Abusive: While my husband bears a great deal of anger towards his father, he has forgiven him. Nonetheless, painful memories still exist.
  2. He was close to his grandmother who raised him: My husband is the youngest of four siblings, and didn’t get to know his parents very well. Fortunately, for this reason, he seems to have repeated fewer of their mistakes.
  3. He never knew his mother who was an alcoholic and drug addict: He never new his mother very well since she wasn’t around. Due to lasting effects of prolonged substance use, she lasting cognitive deficits later in life. This made a relationship with her impossible.
  4. Divorce is common in my husband’s family: Excluding my husband and his half-brother Wesley, everyone has been divorced at least once.
  5. He isn’t close to his siblings: He is not close to his siblings Galen and Kathy. Since they are repeating many of the unhealthy patterns of his parents, he as chosen to distance himself from them. He doesn’t want this sort of influence upon our two sons.

References

Galvin, K. (2015a). Genograms: Constructing and interpreting interaction patterns. Retrieved
​from: http://genograms.org/introduction

Galvin, K. (2015b). Clues. Retrieved from http://genograms.org/clues-2/

Galvin, K. (2015c). Symbols. Retrieved from http://genograms.org/symbols/

Genopro [Computer Software]. (1998). Retrieved from: http://www.genopro.com/setup/
Genopro (2015). Introduction to the Genogram. Retrieved from:
http://www.genopro.com/genogram/

Metcalf, L, (2011). Marriage and family therapy: A practice oriented approach. New
York: Springer Publishing Company

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NCE – Murray Bowen Family Systems Therapy

Definition of Murray Bowen’s Family Systems Therapy (MBFST)

​Developed by Dr. Murray Bowen, MBFST involves a systems perspective reflected in the other theories discussed thus far.  According to MBFST, families have relationship systems in which individuals function interdependently. Consequently, underlying issues within families is a complex circular causality that diverges from the linear thinking standard in conventional therapy. MBFST describes three inter-relational family systems: (1) an emotional system, (2) an intellectual system, and (3) a feeling system. While the emotional system is an inter-relational byproduct of our primitive limbic brain, the intellectual system represents the efforts of our prefrontal cortex. Finally, the feeling system appears to be a Hegelian dialectical concept that combines insights of two previous systems. What I appreciate most about this theory is it considers the well being of the family unit as well as the individuals who comprise it. This is what makes MBFST unique, in my opinion. For example MBFST describes a process of self-differentiation that seems similar to the Jungian concept of individuation. While family relationship systems function is interdependent in nature, it is vital that this reciprocal functionality promotes individual well-being. What has frustrated me with several of the previous theories, are that they can, at times, gloss over this fact.

“Key Concepts”

Degrees of Differentiation

​Coming from a medical perspective, Dr. Bowen’s concept of differentiation reflects the biological notion of cell specialization (Metcalf, 2011, p39). Within all families, individuals develop the ability to function independently within this reciprocal relationship system. This process of differentiation allows individuals to balance opposing drives and functions, dialectically. Internally this process of self-differentiation occurs as we learn to balance insights from within the intellectual and emotional system (Metcalf, 2011, p43). Externally, the process of self-differentiation allows us to remain as separate individuals while remaining connected to the family (Metalf, 2011, p43). I find the textbook’s description of high and low levels differentiation an interesting point of comparison. Low levels of differentiation encompass emotionally driven and reactive behaviors that result in other-driven life paths (i.e. conformity or rebellion). In contrast highly differentiated individuals are capable of managing anxiety and think through feelings rather than with them. Additionally, highly differentiated people retain a strong sense of self while maintaining a healthy connection with others.

Triangles

“The triangle structure is a three-person emotional con guration that is the basic building block of any emotional system. Triangling describes the process of the predictable patterned moves of emotional forces between any three people” (Metcalf, 2011, p. 44).  For example, Metcalf offers the scenario in which a mother and child have an overly-close position and the dad is like an outsider.  In such situations you see a natural “flow and counter flow” (Metcalf, 2012, p. 44).

Nuclear Family Emotional System

This concept refers to common symptomatic patterns in a single generation nuclear family system in which poor differentiation has occurred.   For example, emotional distancing can occur when we attempt to maintain some emotional separation from another family member to avoid our reactivity to their own emotions.  Another example of this is cyclical marital conflict.

Family Projection Process

“This concept describes the primary manner by which parental undifferentiation is projected onto one or more children, resulting in impaired functioning (Kerr, 2003). Parents scan a child for potential problems, diagnose the child’s behavior as con rmation that the problem exists, and then treat the child as though the diagnosis is accurate, shaping the child’s devel- opment through the parents’ undifferentiated projection lens. Inherited problems that affect children most include (a) excessive need for attention and approval, (b) dif culty dealing with expectations, (c) blaming self or others for problems, (d) assuming responsibility for others’ happiness or subjugating personal happiness to others, and (e) relieving anxiety by acting impulsively rather than tolerating anxiety while acting thoughtfully (Kerr, 2003).” (Metcalf, 2011, p. 46).

Multigenerational Transmission Process

This concept seems to point toward a tendency for families to pass a psychological history from generation to generation.  Unhealthy beliefs, attitudes, behaviors, and habits inevitably get passed from generation.  “For Bowen, differentiation of family members is a key indicator of family functionality: greater differentiation leads to greater flexibility and independence from emotional forces and a lesser likelihood of developing emotional difficulties. When differentiation is low, the family is described as an “undifferentiated ego mass” [Bowen 1978]. The emotional boundaries of family members are blurred and permeable. Family members tend to be bound to emotions, dependent, and easily stressed into dysfunction” (Hurst, et al, p. 695).  For many raised in poorly differentiated families we can spend good chunk of our lives getting over messages from our childhood of what we are to think and feel as well as what we should be.

Emotional Cuttoff

“Emotional cutoff is expressed in internal process by denying the attachment, in external process by physical separation, or by some combination of the two (Papero, 1990). Kerr stated that emotional cutoff re ects a problem of generational fusion, solves a problem by reducing anxiety that comes with uncomfortable contact, and creates a problem by separating people from important relation- ships and intensifying fusion in remaining relationships ” (Metcalf, 20-/, p. 47).

Societal Emotional Process

This intriguing concept has me both intrigued and befuddled.  Metcalf (2011) states: “This concept addresses ways that families shape society and society shapes families…. The emotional system drives functioning at all levels— families, society, work, social organizations…The triangling process observed in families is played out in society with the same variables in the process: 1. Emotional tension (i.e., anxiety) grows between two groups. 2. Emotionally vulnerable others are involved, and the anxiety spreads. 3. Emotional reactiveness, defensiveness, and counterattacks feed the anxiety. 4. Emotional energy is spent, and the system calms.” (p. 74).

Strengths & Weaknesses

​The strength of this theory is in its ability to accurately depict the relational context in which individuals grow and develop. The concepts of a solid versus pseudo selves in MBFST depict this notion vividly (Metcalf, 2011, p44). A solid self is reflected in realistic expectations of others and a solid understanding of who we are. The pseudo-self comprises an other-defined self, and an inability to function outside of a reciprocal and interdependent relational context. Together, these two concepts remind me very much of two children’s books of mine by Shel Silverstein, author of “The Giving Tree”. In my opinion, “The Missing Piece”, and “The Missing Piece Meets the Big O”, effectively illustrates the differences between a pseudo and solid self.

​Metcalf, (2011) makes a statement about MBFST that it is theory driven. It provides a manner for conceptualizing issues and a roadmap for the therapy process. In this respect any limitations of this approach pertain to the idea that the situation itself is defined by theory. Finally, the concept of differentiation, as discussed earlier, is a culturally relevant term. While this concept works well in our individualistic society, it may not work in families with a collectivist cultural orientation.

Theoretical Assumptions

  1. View of Family – “Bowen (1978) defined the family as follows: The family is a system in that a change in one part of the system is followed by compen- satory change in other parts of the system. I prefer to think of the family as a variety of systems and subsystems . . . I think of the family as a combination of “emotional” and “relationship” systems. The term “emotional” refers to the force that motivates the system and “relationship” to the ways it is expressed. (pp. 155, 158)” (Metcalf, 2012, p. 48)
  2. Process of symptom development“An individual’s ability to adapt to life is most strained by events that (1) threaten his emotional connections with others; (2) increase the anxious focus of others on himself; (3) increase his dependence on others; (4) increase the dependence of others on him; (5) threaten the function- ing of others upon whom he is dependent; or (6) increase his level of responsibility. (p. 105)” (Metcalf, 2011, p. 48-49).
  3. How change happens “In Bowen theory, therapeutic change occurs when one person focuses on accepting responsibility for self within the family and in life, developing awareness of the differences between emotional and intellectual functioning and creating problem-solving options based on those differences” (Metcalf, 2011, p. 49).

a working template

  1. Tool for Change – “the therapist is responsible for working on differentiation of self in his or her own family…The therapist works to get clients to lower anxiety by reducing emotional reactivity so that the client can access his or her thinking process…The therapist helps identify predictable reactions (avoidance, going along, conflict, overfunctioning)…Throughout therapy, the therapist should ask process questions to increase the client’s awareness of family emotional process and the client’s role in them.” (Metcalf, 2011,  p.  51).
  2. Joining & Building Rapport –  Engage the clients’ to begin thinking about their role in things and encourage self-responsibility.  Work on helping everyone manage their emotional reactivity while constructing a family genogram
  3. Understanding Present Issues –help family understand individual behavior problems and emotional reactions as byproducts of the family system.  “over time, the therapist and family member(s) develop a broader, more factual, and objective perspective on the presenting issue, on factors driving the anxiety, and on his or her own reactivity and that of others.” (Metcalf, 2011, p. 52).
  4. Assessing Family Dynamics –utilizing the concepts discussed previously, the goal is to understand the underlying patterns and family dynamics that help explain the current problems this family faces: (i.e. Addiction, divorce, abuse, etc)
  5. Create Goals – “The goals of Bowen therapy include placing the presenting problem in multigenerational context/system, decreasing anxiety within the family members, Detriangling three-person systems, and increasing basic differentiation of self among family members.” (Metcalf, 2011  p. 53).
  6. Amplify Change-“change occurs when each client achieves a reasonable level of understanding about his or her family history, his or her roles, and the roles of others. It is hoped that the client will then begin to change and differentiate as he or she becomes aware of his or her patterns of relating in family systems. Progress is measured by how quickly clients recover from emotional reactivity and their ability to create a workable plan to maintain self” (Metcalf, 2011, p. 53).

References

Hurst, N. C., Sawatzky, D. D., & Pare, D. P. (1996). Families with multiple problems through a Bowenian lens. Child Welfare, 75(6), 693.
Metcalf, L, (2011). Marriage and family therapy: A practice oriented approach. New
​York: Springer Publishing Company

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Solution-Focused Family Therapy…

Starting with a review of Old Notes…

First a Definition…

“Solution-Focused Brief Therapy (SFBT) is a future oriented, goal-directed approach to brief therapy that uses questions designed to identify exceptions (times when the problem does not occur or could occur less in the client’s life), solutions (a description of what life will be like when the problem is gone or resolved), and scales which are used to measure the client’s current level of progress toward a solution and reveal the behaviors needed to achieve or maintain future progress.” (Metcalf, 2011, p.) 287)

  1. Focused on the Present not the Past
  2. Postmodern  & Social Constructionist 
  3. Pragmatic – Structure rigidly imposed
  4. Client is the expert…not pathological.   

Assumptions of SFT

  1. “Clients have resources and strengths to resolve problems
  2. Change is constant.  The therapists job is to identify/amplify change
  3. It is unnecessary to know about the complaint in order to solve it
  4. small changes in one part of the system can affect changes in another part of the system
  5. Clients define the goals.
  6. Rapid change or resolution of a problem is possible
  7. There is no one ‘right’ way to view things, different views may be just as valid and may fit the facts just as well.
  8. Focus on what is possible and changeable, not what isn’t.” (Metcalf, 2011, p. 293).

How Change Happens…

Change happens by learning to see the problem different and constructing new stories about what is happening.  Therapists help clients find exceptions to their complaints and believe change is possible. This allows the client to think different and think of solutions.

Therapist Role & Interventions…

The therapist works collaboratively with the client to construct solutions.  The client is the expert.  SFT has two main strategies:

Questions

“Are designed to help the client focus on exceptions and make presuppositions about future actions while building a positive outlook and encouraging achievement.”  (Metcalf, 2011, p. 296).  there are three types of questions…

  1. MIRACLE QUESTION – “Ask client to think about what things would be life if the problem no longer existed and instead you could have your preferred future.” (Metcalf, 2011, p. 298).
  2. EXCEPTION-FINDING QUESTIONS  – “Asks clients to think about times when their troubles were less severe, frequent or altogether absent.” (Metcalf, 2011, p. 298).
  3. SCALING QUESTIONS – “Client’s rate how they feel on scale of 1-10.” (Metcalf, 2011, p. 298)..

Interviewing Techniques….

“Serve to validate concerns and assist clients in experiencing significant shifts in their thinking about their situation” (Metcalf, 2011, p. 296-298).

  1. The client is the expert, the therapist promotes change.
  2. Discussion is problem free and instead focuses on solutions.
  3. Utilize compliments to help normalize client’s experiences….

A Working Template…

  1. PHASE ONE – “JOIN AND BUILD RAPPORT”: Introduce yourself and greet everyone, explain role as SFT family therapist. “My name is ____. As we begin talking, it would help me to get to know if you would tell me more about yourself and what you appreciate about each other.” (Metcalf, 2011, p. 299).  
  2. PHASE TWO – “UNDERSTANDING THE PRESENTING ISSUE”: Ask why they entered therapy and listen as they clarify the issue and what they hope to accomplish. Normalize and create exemptions…. “How do you explain your ability to ______ during this time?” (Metcalf, 2011, p. 299).  
  3. PHASE 3 – “ASSESSMENT OF FAMILY DYNAMICS”: Doesn’t assess presenting issue, but provide possibilities and solutions. “Could you describe the times when the problem occurred less?” (Metcalf, 2011, p. 299).  
  4. PHASE 4 – “GOALS”: specify the client’s goals that will be relevant and meaningful to client. The Miracle Question: “Suppose tonight while you sleep, a miracle occurs. When you wake up tomorrow, what will be different?” (Metcalf, 2011, p. 299).  
  5. PHASE 5 – “AMPLIFYING CHANGE”: Whenever you hear exceptions, verbalize your discoveries with curiosity and sincerity to the client, even if the exceptions are slight. “What difference did that make for you?” (Metcalf, 2011, p. 299).  
  6. PHASE 6 – “TERMINATION”: Each week, ask the clients whether they wish to come back, and if so, when. This puts them in charge of therapy. “What did we do during our time together that you found helpful, if anything?” (Metcalf, 2011, p. 299).  

References

Metcalf, L, (2011). Marriage and family therapy: A practice oriented approach. New York: Springer Publishing Company

Discussion Board Post 2.1

Definition of Solution Focused Therapy

Solution Focused Therapy is form of brief therapy that is very goal-oriented in its approach. Instead of examining the problem, it directs the client’s attention toward solutions (Metcalf, 2011). Instead of focusing on reliving the past, it focuses on changes to create in the client’s desires for the future (Metcalf, 2011).   Since reality is conceived as a constructed, rather than absolute concept, the client is the expert not the therapist (Metcalf, 2011). It is for this reason that the therapist’s role is collaborative in nature, and involves redirecting the client toward possibility.   The primary goal of Solution Focused Therapy is empowerment for client in whom emotions are validated in a brief and highly structured context (Metcalf, 2011).

Two Concepts: Social Constructionism & Postmodernism

            Metcalf, (2011) briefly mentions postmodernism and social constructionism as two theoretical underpinnings to this approach. Since I was interested in understanding what these terms met, I thought I’d search the library’s database.   Social Constructionism essentially points at the self-fulfilling nature of society’s influences upon us (Social Constructionism, 2008). In other words, our everyday experiences are comprised of an array of socially defined concepts ranging from personal identity, social interaction, beliefs, values, thoughts, and feelings (Social Constructionism, 2008).   According to Metcalf, (2011) postmodernism appears to assert that truth is essentially a matter of subjective interpretation and not objective fact. When taken together, these two perspectives create a view of the individual as the creator of his/her experience.

Strengths & Weaknesses

One strength of Solution Focused Therapy, is its pragmatic and brief nature. These two qualities are especially attractive in light of the influence of managed care and popularity of brief therapy.   Additionally, as a logical and easy-to-understand approach, it is easy to explain and provides quick solutions for clients.

The weaknesses associated with Solution Focused Therapy can be understood in terms its one-sided perspective. As Metcalf (2011) explains Solution Focused Therapy sees individuals as creators of their reality, and in this respect the experts. Clients are never viewed as “never pathological or resistant” (Metcalf, 2011, p291) in Solution Focused Therapy. In mental health, pathology refers to the causes and effects of psychological disorder.   As mental health professionals, it seems impossible to do our job if we are unable to attend to the presence of a psychological disorder.

Additionally, Solutions Focused Therapy has its limits from a cultural perspective. For example, this method may not be a good fit for individuals with a cultural background that includes a collectivist orientation. This is because Solution Focused Therapy excludes generational patterns, family history and past experience as relevant factors to its overall approach (Metcalf, 2011).

References

Fischer, R. K. (2014). Postmodernism. Reference & User Services Quarterly, 54(1), pp 29-33.

Metcalf, L, (2011). Marriage and family therapy: A practice oriented approach. New York: Springer Publishing Company

Social Constructionism. (2008). In W. A. Darity, Jr. (Ed.), International Encyclopedia of the Social Sciences (2nd ed., Vol. 7, p. 578). Detroit: Macmillan Reference USA.

Finally, Discussion Board Post 2.2

Initial Reaction

The video assigned this week provides a vivid example of how Solutions Focused Brief Therapy can work with families and couples. At the introduction of this video, Isoo Kim Berg mentions several notable key points. Firstly, with this therapy model, building solutions involves focusing on exemption finding (I’d Hear Laughter, 1997). Secondly, the miracle question is reflective of the therapist’s role in assisting clients to build their own solutions (I’d Hear Laughter, 1997). Finally, scaling questions, allow clients to assess their progress in a manner that doesn’t impose the therapist’s ideas of normalcy (I’d Hear Laughter, 1997).

I appreciate this therapy method due to its pragmatic and brief nature. It defines reality as a personal and social creation and not objective fact (Metcalf, 2011). As a result, the therapist is able to utilize an approach that validates and respects a client’s own perceptions. The limits of this method are related to the fact that it can at times move too quickly to a solution, without first examining the problem carefully. Metcalf’s (2011) utilization of the Cinderella story in chapter one provides an excellent illustration of this.  Individual and family therapists would address the Cinderella story differently due to divergent views of the problem, (Metcalf, 2011). When applying this insight to the video, I wonder if any issues were left unaddressed. For example, what about the tension between Lou and Jan? I would like to know more.   How was Lou’s difficulty finding a job influenced by his overall well-being? Finally, is there more to Sarah’s story that didn’t come out in the sessions? In life, I believe problems are not simply a matter of what we are experiencing, but how we choose to define them. Sometimes the best solutions in life come from a shift in perspective in the absence of any action.

The Miracle Question

The miracle question plays a pivotal role in Solution Focused Therapy and involves asking the client to imagine a life in which one’s problems were suddenly eliminated (Metcalf, 2011).   In this video, Insoo asks the clients to consider if they woke tomorrow and discovered their problems were just 10% improved, how life would look (I’d Hear Laughter, 1997). Jan states she would expect everybody up in the morning ready to start the day, and willing to engage in meaningful interaction. Lou would wake up to a kiss from his wife, and Sarah stated the home environment would be much lighter.

In this specific video, I do feel the Miracle Question is useful in achieving its goal of encouraging the clients to formulate a solution. Through a series of questions, the therapist assists the clients as they clarify what actions could yield meaningful change. They are enabled to see life in new ways and let go of the problem by focusing on a solution.

How Was Therapist Effective?

I do feel this therapist’s techniques were effective, because the family’s problems weren’t very complex in nature. Issues more complex such as alcoholism, mental illness, or abuse, wouldn’t be suitable for brief therapy.   The therapist’s greatest successes were in her ability work with the clients to formulate a problem. This began as they discussed the changes they sought.   Assigning homework and discussing progress in a follow-up session, allowed for the experience of a quick remedies to their problems.

Is This Model A Good Fit For Me?

I feel it is way too soon in my development as a future therapist to decide on a specific theoretical perspective. Nonetheless, I do feel Solution Focused Therapy is useful as brief and pragmatic perspective that empowers clients to create change that aligns with their life goals. When applicable in this respect, I can certainly see using it in the future at some point.

References

I’d Hear Laughter [Video file]. (1994). Psychotherapy.net. Retrieved September 8, 2015, from The Psychotherapy.net Collection.

Metcalf, L, (2011). Marriage and family therapy: A practice oriented approach. New York: Springer Publishing Company

 

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