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Theory and Design in Counseling and Psychotherapy
Susan X Day , Iowa State University and University of Houston
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CHAPTER 10: Systemic Approaches: Family Therapy
Key Terms and Essential Concepts
Nuclear and extended family: Nuclear family is the basic group
consisting of parents and children. Extended family branches out to include
grandparents and other close relatives or friends that have consistent or powerful
impact on the basic group.
Family life cycle: Family relationships naturally and inevitably
change as the nature of the system changes with births, deaths, children growing
up, children leaving, job changes, retirements, and so on. Young children who
are dependent on parents eventually grow up and establish independence. Marriages
change as career efforts dominate for periods of time and gradually recede in
priority. Separateness and connectedness may be helpful and harmful depending
on the context of the family’s place in the cycle.
Family of origin: In an intergenerational view of an extended
family, the family of origin is the unit where a particular person is born.
Homeostasis: A system, or a family, operates in ways that will
move toward an equilibrium of all of the factors that influence the group. Needed
adaptations are made in a fluidity that allows for change. A basic stability
is retained so the system can continue functioning. Homeostasis is disrupted
by family conflict and tension within the system, and the system will create
mechanisms to keep the group together.
Child goals: Dreikurs, an Adlerian author, proposed
four purposes of children’s behavior: getting attention, power, revenge, and
withdrawal. Bitter described three more goals: getting, self-elevation, and
avoidance of tasks. Children in counseling will show a verbal or nonverbal recognition
of these goals as reasons for their behavior or misbehavior. Parents and counselors
can teach children more effective means to meet their psychological needs.
Symptom functionality: A major tenet of family systems thinking
is the concept that the symptoms shown by a family member serve a purpose to
maintain the group’s interaction and cohesion. When the family focuses on one
member’s difficulties, other anxieties in the system are ignored or reduced.
Parentification: A family dynamic that requires a child to
take on the role of a parent may mean the child becomes one spouse’s confidant,
or one sibling becomes the caretaker for other children, or the child does adult
responsibilities such as cooking for the entire family or bill paying. In essence
the child is no longer treated as a child and the level of responsibility impairs
the child’s experiencing childhood activities. Depending on the degree of parentification,
natural psychological development can be impeded and interactions between family
members can be affected.
Problem-determined system: When family dynamics revolve around
an identified problem, solving the problem could disrupt the family’s sense
of belonging. Discussing the problem is a family activity, rarely including
outsiders, so the conversation increases cohesion among members only. A problem-determined
system includes everyone who is concerned with the problem, including nonfamily
members and sometimes excluding a family member.
Identified patient: The family member who demonstrates problems
that upset the family is usually named as "
the problem"
to the counselor. From
a family system perspective, the identified patient could be acting in ways
that serve a family function. For example, a child’s difficulties could be a
means to force the parents to cooperate and draw attention away from marital
difficulties.
Scapegoat: The behavior of a person in the family is blamed
for the system’s difficulties. Scapegoats can be acting inappropriately according
to societal expectations or not. The "
misbehavior"
could be violations of unreasonable
family rules.
Systemic: This approach to family therapy is characterized
by multigenerational concepts, genograms, and the family projection process.
The systemic approach describes how families manage chronic systemwide anxiety
and the effects of differentiation and fusion. Interaction patterns are explained,
particularly how three members form a triangle of communication to defuse the
conflict between two members.
Differentiation: The person who has the ability to separate
emotions from rational thought is able to distinguish between automatic feelings
stemming from current and historical systemic influences. Differentiation as
to internal workings within the person allows the person to separate his or
her own identity and assessment of situations from the group’s.
Fusion: When individuals do not distinguish between thoughts
and emotions, they react according to emotional patterns of alignments and unconscious
acting out of historical experiences. Unhealthy fusion patterns within families
create rigid, dysfunctional boundaries closed to outside influences. Passing
down low differentiation from one generation to the next can develop into mental
health difficulties characterized by fusion, such as schizophrenia, where the
person cannot effectively discern reality from inner projections.
Triangle, triangulation: A specific type of coalition is a
subgroup of three people, where two of the people are in conflict and a third
person relieves some of the tension between the two. Such an arrangement can
be positive with the relief provided; but at other times and if the pattern
is maintained over time, communication becomes triangulated—an unhealthy dynamic.
When direct communication between the two people in conflict is thwarted, suspicions
or other negative emotions are increased and the system’s functioning becomes
rigid, and unable to make necessary adaptations to changes to the family life
cycle.
Pseudoselves: When a person’s identity is designed to conform
to group norms whether or not
the social expectations have a rational basis, the person is seeking only to
belong. Such
an identity is labeled as an example of fusion where emotionality overtakes
thoughtful considerations.
Family projection process: Family members share an emotional
common ground and difficulties with one member, or with a subgroup, are felt
by all members. Likewise difficulties in the system’s structure create problems
for individuals. An individual person’s concerns may be reflecting problems
related to the system as a whole or with any part of the group. Problems are
projected onto individuals and onto the system.
Chronic anxiety: A general fear that has no specific object,
or has so many objects that it reoccurs consistently, affects a person’s ability
to function. In family systems approaches, anxiety can be a characteristic of
the group as a whole. Methods to stabilize the family dynamics control systemwide
anxiety, and when the tension is continually repetitive, the controlling mechanisms
are built into the patterns of interactions.
Multigenerational transmission process: Some patterns of past
generations are carried into the next generation’s families through conscious
and unconscious processes. Each adult who carries responsibility for the functioning
of a family has experienced the effects of previous modeling by older family
members. Many attitudes such as time orientation, spending patterns, parental
disciplining and teaching of children, values, and behavioral standards are
transmitted from one generation to the next. Cultural influences are embedded
within the expectations that have been developed throughout family history.
Genogram: A diagram using boxes (for men) and circles (for
women) and other symbols depicts family members across generations. Ages and
sex are noted. Themes, values, disorders like alcoholism, or occupations may
be noted to show influences across time.
Structural: This approach to family therapy describes the system’s
set of rules—explicit and implicit. The boundaries between the family and outside
influences, as well as subsystems and coalitions, create the basic group structure.
Also, the interactions between members are described on a continuum from too
close to too distant.
Rules: Systems, like families, develop expectations for members
to follow to maintain the functioning and homeostasis of the group. Communication
patterns, appropriateness of activities, the power to make decisions in different
areas, and so forth are understood and maintained by individual members to create
a stable atmosphere.
Subsystems: Within the larger group, smaller groups support
the interests of their members. Interactions between subgroups form patterns
that are a part of the complexity of the system as a whole.
Coalition: Alignments of some portion of a family create coalitions
or subsystems. The children are often a coalition divided from the parents who
are another subgroup. Within the subsystems there may be further coalitions
as in sibling groupings. Sometimes an ad hoc coalition forms for a specific
short-term goal.
Boundaries: The psychological division between people, or between
a system and outside influences, creates the degree of separation needed for
individual identities or distinct systems.
Closed systems: A family or another group that is impervious,
or resistant to, outside information or influences is labeled as closed. An
open system allows interactions and influences from the outside and with other
systems. Closed systems are less adaptable and open systems more able to change.
Families with secrets such as home violence and alcoholism are likely to be
closed systems.
Permeable and Impermeable: Boundaries can be permeable, allowing
for connections between people and opening up to outside stimulation. Boundaries
can also be impermeable, forbidding human contact and staying closed to outside
pressures.
Disengagement: On a genogram too much distance between family
members is indicated by two parallel lines with a slash across the lines. The
symbol indicates that the people are not engaged emotionally and may communicate
infrequently.
Emotional cutoff: As a simile for disengagement, people are
emotionally cut off from each other when they are separated without emotional
exchanges. With no feeling connection to other family members, emotional cutoff
allows the person to figuratively run away.
Enmeshment: When family members, or people in relationships,
are so close emotionally that it is difficult for them to separate their individual
thoughts and feelings, distinct identities are not fully maintained. The blending
of feelings and identities is labeled enmeshment. Family system approaches
define enmeshment as too much closeness and indicate the unhealthy pattern by
three parallel lines on a genogram.
Strategic: An approach to family therapy where therapists are
known for tactical interventions that disarm clients into changing their perceptions.
Clever techniques include circular causality, paradoxical intention, the miracle
question, and reframing. Therapist directives are designed to target particular
attitudes and behaviors without necessarily explaining the purpose to clients.
Circular causality: A change in any part of a system affects
all other parts of the system. In families, one individual’s changing will affect
all the others and all the interacting subsystems.
Circular questioning: The counselor asks the same question
to each and every member of the family, bringing out the circular causality
in the system and helping people realize the interrelatedness of their emotional
lives.
Miracle question: Clients are asked how their lives would be
different if a miracle occurred and their problems were solved. Such a technique
induces a new mind-set in that clients’ answers create a vision of living without
the difficulties that often dominate their views.
Cognitive restructuring: The counselor reinterprets the client’s
thinking patterns or supports a more positive view of a situation. With a new
structure, the family or individual client may be able to gain a new way of
perceiving even though the basic facts of an event are not changed. However,
the implications of the situation are changed.
Reframing: The counselor attaches a new frame on the meaning
given to particular situations or interactions. Similar to cognitive restructuring
but usually used for more specific verbal restructuring, a word or phrase is
changed.
Intellectualization: Although intellectual functioning is held
to be a major coping skill to manage emotions and stress, intellectualizations
are verbal defenses to hide feelings or to justify bad behavior.
Paradoxical intervention: As with individual clients, the counselor
may ask the family to exaggerate a symptom with the hidden agenda to demonstrate
that doing the system deliberately gives the client control. Also exaggerating
the symptom brings new perspectives for clients who may discover the symptom
does not bring the results expected.
Experiential: Another family system approach is noted for its
use of techniques that are designed to create evocative emotional experiences,
rather than simply talking about issues. Experiential family counselors join
in family experiences, becoming participants in the family interactions. This
approach emphasizes the need for families to be aware of current here-and-now
emotions and the unhealthy effects of alienation and emotional deadness. Therapy
is designed to create congruent communication and growth experiences.
Congruent communication: When a person’s verbal content matches
the nonverbal presentation of the message, the communication is said to be congruent.
In contrast, when a person’s words say one thing, but the emotional tone or
body language relays a different message, the communication does not match,
or is incongruent. In families, incongruent communication confuses interactions
and/or lets a member conform just enough to not be too disruptive.
Emotional deadness: When a family rarely, if ever, expresses
emotion and lacks spontaneity, the lack of animation is striking, without a
sense of aliveness. Some families may be typically emotionally responsive but
demonstrate emotional deadness around one issue or topic.
Reprocessing: Experiential family therapists encourage family
members to become aware of deep underlying feelings and for all family members
to recognize the powerfully felt emotions faced by others in the group. By empathically
noting the full emotions of each family member, people gain a sense of the full
experience of themselves and others. Reprocessing assumes that experience has
been processed in an incomplete or flawed way the first time or habitually.
Primary and secondary emotions: Surface emotions easily shown
to others are considered secondary feelings with primary emotions defined as
deeper, underlying feelings. Experiential therapies are designed to uncover
deeper feelings and to encourage family members to understand one another’s
primary emotion.
Parts party: An experiential technique also used in Gestalt
therapy where one family member directs the others to enact parts of the director’s
self. Everyone is able to experience the focus person’s issues.
Narrative: The stories that families tell about common experiences
of the members or about previous generations communicate meanings that characterize
the group. Client narratives attach meaning and values to plots and characterizations.
Therapists from this approach encourage storytelling to externalize the influences
on clients, making the meanings explicit. Therapeutic letters may be assigned.
Or, clients may be asked to note occasions when problems seem to disappear.
Reflecting teams may observe family sessions and share their thoughts with clients.
Counselors may also suggest new meanings for client problems, encouraging new
perceptions.
Externalization: A well-known technique of narrative therapy
where problems are labeled and given personal characteristics. So the "
crappy
attitude"
invading a family suggests that the people have other attributes that
are not encompassed by a labeled problem. The external term can be handled with
new enthusiasm even if change was resisted in the past.
Social constructionist: The concept that people define meanings
based on family patterns or stories suggests that motivating values are socially
learned. The social constructions are held internally by individuals and may
be unconscious. Individuals may try to force situations to conform to internal
views. The underlying connotations of narratives or the applicability of stories
to new situations can be reanalyzed by individuals or families in therapy to
create change.
Reflecting team: For some systems counseling, the counselor
and clients are observed by other therapists behind a screen. At some point
in the counseling session, the reflecting team discusses what has occurred in
the session and the clients gain multiple perspectives.
Unique outcome: Clients are asked to describe the times when
they were able to react differently than the typical times when problematic
reactions occur. Such a description offers hope
that difficulties are not unsolvable and that the client does have the capacity
to behave differently.
Neutrality: Some schools of thought expect the counselor to
remain neutral in relating to members of the family, suggesting that alignments
with any one member or subgroup harm objectivity. The counselor’s stance is
one of curiosity, maintaining communication and understanding, but not becoming
a family participant. Interventions may induce change in the system by introducing
something new.
Joining: When the counselor enters the family system by participating
in the family interactions and conforming to the family rules, the therapist
is said to be joining. Such participation allows the counselor to assess the
dynamics and determine what changes and interventions are needed.
First-order and second-order change: When families make a change
that reduces conflict, or anxiety, it is called a first-order change.
When change entails a deeper transformation that alters the actual structure
of the system permanently, it is called a second-order change.
Accommodation: The counselor adapts her use of specific language,
phrases, and emotional tone to the style of the client or the family. Accommodation
is the means for the counselor to insert herself into the family system. This
is called joining.
Curiosity: Bowen’s style of family therapy includes a neutral
stance where the counselor observes the family as a curious onlooker who wonders
how the different interactional patterns work to keep the system operating.
Curious inquiries may influence the system to reflect on itself and open the
door to new patterns.
Family drawing technique: A visual technique to show how the
client views the family. A kinetic drawing specifically shows family members
doing something together.
Family mapping: Using boxes and circles as in a genogram, each
family member is named and given three descriptive adjectives. Then a descriptor
is given to depict the nature of the relationship between each pair of individuals
within the family. The result is a picture of how the client views each
person and the interrelationships. Family members can exchange maps and discuss
similarities and differences in their views.
Family sculpting: An experiential technique has all family
members creating a pantomime to show a meaningful scene from their lives together.
One member directs the others to place themselves in specific ways and to do
specific things; then everyone discusses the meaning of the act.
Letters: Clients are asked to express what they would want
to say to someone in letter form. In writing a letter, the client does not have
to face the person directly but still has the opportunity to collect his thoughts
and communicate them. The letter may very well never be sent, but the experience
of communicating in this form can offer relief.
Goals: Dreikurs, an Adlerian therapist and author, proposed
children reveal four major purposes for misbehavior: attention getting, power
struggle, revenge, and withdrawal. Other goals include: getting, self-elevation,
and avoidance. Children will typically acknowledge why they behaved as they
did by openly agreeing to a counselor suggesting such goals or by displaying
a "
recognition reflex"
in their facial expression. Since children are not fully
conscious of the reason behind their behavior, acknowledging the motivation
and discussing other behaviors to gain goals is helpful.
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