Family and Individual Therapy

Family and Individual Therapy
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  • I. Family Therapy and the Family Systems Perspective
  • Early Social Work theory focused upon the family as an open system. Mary Richmond was a pioneer in the Social Work profession. Her Social Diagnosis theory and the use of the family visitors initiated the practice of social casework and case management. Jane Adams was another pioneer in the Social Work profession. Jane established the Jull House Settlement House organization that was modeled upon English Settlement houses. Soon practitioners were moving to the suburbs and entering into private practice. This private practice interloped into individual therapy and family therapy evolved. While the focus of the initial pioneers in the Social Work profession was the individual in the family, the pioneers in family therapy focused upon support of the family system. These theorists include Bateson, Haley, Whitaker, Minuchin, Satir, Nichols, Jackson, and Bertalanffy. This change in the focus of treatment from the individual to the family makes the assumption that the presenting difficulties are an indication that something may be going on in the family unit.
  • In 1920 the social work profession the Child Guidance Movement made a connection with group treatment. Theorists worked with groups using the tools that involve content (what) and process (how) along with role theory. This was a contrast form the medical model that was used in 1909 when psychiatrist made great use of medications, diagnosis, and treatment plans in conjunction with psychological testing. Then in 1948 the theory of causation implicating the schizophrenic mother evolved. Later in 1940 Bowlby, Ackerman, Freud, and Harry Stack Sullivan surmised a theory regarding the interaction of schizophrenics while Bateson worked in mental health with schizophrenia families, meta communication and the double bind theory. This had come a long way from the theory in 1920 involving an exploration into how stuff works, and the cybernetic study of machines and the study of information; establishing a challenge of the space between things. By 1986 the feminist movement began the conversation about closed systems, and informing the profession that “families are families” which was partly an attack on the homeostasis theory and the resistance to change.
  • Around the time of WWII, in 1942 the Macy Conference began a series of annual meetings for the next nine years. The topic of the era was cybernetics…loops of positive and negative feedback that encourage interaction in families. Family therapy had an impact with the profession prior to the concept of the use of group work. Kurt Levin happened upon the work with groups. He believed that something happens in the group that makes them an entirely different entity. Family therapy became a treatment of description. Ackerman became one of the first theorists to change the face of family therapy. Minuchin used Sullivan’s theory of the psychotic patient to broaden his theory of the process in the family. There appeared to be a good deal of transition during the 1940’s. In England Bowlby was doing work with the parents and their children. In New York Ackerman was working with the entire family using a psychiatric approach to treatment. In addition, the Child Guidance Clinic moved from England to Chicago, Illinois; the clinic focused upon work with the schizophrenic mother noting that there was something about the home environment that needed an intervention. This opened the door for therapist to encourage treatment with the mother and the child, while placing the blame for the child’s symptoms on the mother.
  • An English anthropologist named Bateson began a conversation about meta communication in the family process of symptoms. Ackerman began a conversation that involved the child and the family; he surmised that the children present with difficulties as the result of the dynamics of the family process. His theory of the family process involved psychodynamics that interlopes into the meta communication. He describes the process as “tickling the defenses.”
  • The family Therapy Systems theory indicated that every family member contributes to the problems of the family. There were as many different approaches to the discovery of these contributions as there was different theorist. Feminist support groups made use of the genograms. Murray Bowen surmised that five generations of the family developed and created the psychotic patient; family problems developed over time through the generations. Jay Haley believed in a strategic system making use of specific sets of techniques to tackle the family challenges. In addition, the Family Institute attempted to teach an integrative model of treatment to their theorists implementing treatment to families. And a psychiatrist for the state of Illinois, Marvin Schwartz, was behind the implementation of laws and legislation that would push for the need to hospitalize teenagers in emotional crises. Freud believed that the family was the problem and that they should be kept out of the sessions for the client. The MRI (founded by Don Jackson) began to slowly move away from seeing the entire family for treatment.
  • Family Systems
  • A. Weiner and the Cybernetics Theory
  • Weiner began to question the process of the intra psychic structure of the individual.

Along with Julian H. Biglow their work with machines and electric systems contended that voluntary activity for engineers involved feedback information. The motion of engines established a pattern that develops into a regular system. This pattern extrapolates into the actual motion involved in the pattern and is used as new input. This input establishes regulated movement that establishes the expected pattern. This feedback pattern allows the engine to have its own independent role in the process. If the feedback is too quick it can cause a disruption that leads to a breakdown. As the two scientists began to see a similar pattern with humans and the nervous system they developed a hypothesis. Their hypothesis summarized that psychopathology in humans develops a similar disruption that develops into uncontrollable behavior patterns. In addition, they added that the human nervous system, neurology, and the muscles (nerves, synapses) were involved in an integrated process of this disruption.

  • These scientists continued to research, and write and exchange ideas about this process. Their conclusion was that the science of engineering, machines, motion and human interactions can be explained by the notion of entropy. Entropy in a system measures the degree, amount, and level of organization; one is opposite of the other. The theory encapsulated and considers the notion of enzymes, catalysts, metabolism, and reproduction, as well as communication. Weiner, Biglow, and Rosenblueth established that a combination of control, communication, and mechanics involved similar processes of the human species. Their enlightment was coined cybernetics which is the Greek translation for steers man (Weiner, 1948).
  • Among his colleagues the discussion about this theory of control and communication went from Descartes, to Greek mythology, to a passive God; producing in us mastered experiences, our free will, and its effects on the external world. The formula of cybernetics began with a concept of transformation, transformation-group, and invariant; each goes into the other. Transformation in A, and then B becomes the resultant BA (which also depends on the order of A & B. If AB & BA are similar then they are determined to be permeable variations within either A or B that can develop into subsystems of elements and are called the identity transformation. Transformations within the set become part of the set which become the transformation-groups. If the sets within the group develop transformation they are called Abelian (Weiner, 1948). If any of these formations within the sub group become rigid or stall they become non-albelian groups. Should the quality of the combined transformation fail to change in the process of the transformation it becomes an invariant of the group. There may be multiple variants. The most important ones are linear invariants (character, character groups), and metrical invariants (group structure, ergodic theory, and transformation of groups). After much contemplation Weiner stated “no measurement which we actually make is performed with perfect precision (Weiner, 1948, p. 75).” “We have thus at least a formal solution of a generalization of the message-noise problem which we have already stated. A set of messages depends in an arbitrary way on a set of messages and noises with a known combined distribution (Weiner, 1948, p. 81).”
  • Weiner’s theory of feedback states “We thus see that for effective action on the outer world, it is not only essential that we posses good effectors, but that the performance of these effectors be properly monitored back to the central nervous system, and that the readings of these monitors be properly combined with the other information coming in from the sense organs to produce a properly proportioned in mechanical systems (Weiner, 1948, p. 114).” “We have thus examples of negative feedbacks to stabilize temperature and negative feed-backs to stabilize velocity. There are also negative feed-backs to stabilize position, as in the case of the steering engines of a ship, which are actuated by the angular difference between the position of the wheel and the position of the ruder, and always act so as to bring the position of the rudder into accord with that of the wheel (Weiner, 1948, p. 115).”
  • In 1980’s there was a battle of the models. The systems theory began to take many individual responsibilities. A concept of levels of communication with the family began the use of metaphors to make the connections. There was the position of psychology and psychopathology and family therapy (Haley, Bowen, Lynn). The second group level was the model of cybernetics. The third level model was with the Family Therapy Institute and their theory of Metaframeworks (class note SW7400, 9-7-13).
  • B. Bateson’ Communication Theory
  • Bateson proposed a new concept of ideas and minds that he called the ecology of mind and ideas; organized theory of knowledge. He questioned the interaction of ideas, the selection of ideas, and their survival/life span opposed to the extinction of other ideas; the economics that limit the growth of ideas; the required conditions for the hubristic life of such a system/subsystem. Bateson’s background was in medical health with schizophrenic families. He later noted the trans meta communication and the double bind in familial relationships. He had no faith in the concept of power in relationships. Bateson surmises that no data is true, raw data; every word has been subject to transformation and editing by some entity.
  • Bateson decided that ideas, the mind, and data constitute the development of the hypothesis. The process goes from data to hypothesis back to data. He stated that the research must utilize two beginnings both with its own authority; observation and fundamentals. He applauds the efforts of Sigmund Freud to conceptualize these efforts to bridge the two (between physical/chemical and behavior). Bateson escaped back to primitive theories of religion, philosophy and science to examine his concepts. By 1942 his aim towards justification shifted to his hypothesis of a second linkage. This was a concept of messages, redundancy, patterns, and meanings. After his work with the anthropologist, Dr. Margaret Mead, his work took on another evolution. Dr. Mead’s ideas regarding man in his culture and values introduced Bateson to the concept of blueprints and interpreting data in our own culture; how man learns and continues to learn.
  • Bateson wrote that communication for humans exist operating on multiple levels. He stated that messages generate a paradox; negative establishes negative metastructure. In addition, his theory included that language makes a connection to objects (maps) as the relationship of a territory to a map. Therefore, communication can only exist once there has been (on a human level) after a complex set of rules, non-verbal metalinguistics exists. This allows the script for the connection of words and sentences that are related to the objects and events. And in therapy the communication level is meta to these rules (Bateson, 1972, p. 191). This notion juxtaposes that the act of play is framed psychologically, spatially, and temporal bonding which is interactive messages-concrete, basic to reality.
  • Bateson reflects back to his work with schizophrenics. He describes this conscious state of communication as chaos, and extreme difficulty with the rules of communication, and receiving messages. Trauma has had a particular structure, interacting with the environment which develops into the pathology for the individual. The difficulty of the exchange of multiple levels results in a misinterpretation of signals. He made the connection between strong context and weak ties. Also, Bateson explored human knowledge and the concept that an inability to know when a message is a message…the network that connects the message. He expressed the belief that along with more education and experience the person will fail less in life.
  • Through his theory of schizophrenia Bateson established a basis for the analysis of communication. He developed the term double bind; you try and you try but still you can’t win. Thus, the individual develops schizophrenic symptoms. When the pattern between mother and child are breached pathology ensues. This develops symptoms of schizophrenia (Bateson, p. 203). The individual was labeled to have weak ego function due to a disparity of communication with the self, or between the self and others. The schizophrenic, in particular, makes good use of unlabeled metaphors because of an inability to correctly process logical signals of communication.
  • Going a step further with his theory Bateson looked at the schizophrenic family structure. He examined the communication sequences between the mother and the child involved in psychotherapy. He developed a hypotheses of the family that had not been tested and it did not explain complex family relationships. His theory denotes the challenges of parenting. He also notes that the confusion that develops as a result of the double bind causes confusion of internal messages, a blocking of emotions, and inappropriate punishment for the child. Bateson stated “according to our theory, the communication situation described is essential to the mother’s security, and by inference to the family homeostasis. If this be so, then when psychotherapy of the patient helps him become less vulnerable to mother’s attempts at control, anxiety will be produced in the mother. Similarly, if the therapist interprets to the mother the dynamics of the situation she is setting up with the patient, this should produce an anxiety response in her (Bateson, p. 221).” “Lastly this theory asserts that if these simple rules of formal discourse are contravened, paradox will be generated and the discourse vitiated (Bateson, p. 280).”
  • C. General Systems Theory of Bertalanffy
  • Ludwig Von Bertalanffy developed his theory in 1940 that combined his profession, biology, with a system involving universal theory of living systems. His first efforts were to investigate the human endoctrine system, and on to complex social systems. Ludwig coined the term General Systems theory. His theory set a precedent for what later developed into Family Therapy. Von Bertanffy defined a system as an entity that consists of parts, from atom to cosmos. These parts were to include specific things like trains, postal systems, and telephone systems; it can take the physical form, scientific form, psychological form, or a symbolic form. In addition, it can be a large system, a small system, as well as part of a country. The one thing that encapsulates this theory is that all/any part of the subsystem that branches out to a larger system.
  • According to Von Bertalanffy this subsystem is beyond being a conglomeration of its smaller parts. Once the smaller entities are collected into the larger system they become organized and it creates a new dimension. His metaphor, organism, was used to connotate (organizational) open systems that begin and end with the interconnection of the environment. These open systems (as opposed to closed systems) stay afloat and revived by exchanging resources within their environment (vertical). The living entity, the human, demonstrate equifinity; the ability to attain goals in a variety of ways (Nichols, 2010). While machines and the theory of feedback denotes a cause-effect connection this human social system theory implies there are multiple results, multiple interactions, and multiple objectives; they live, are alive, and they create a reality. They also effortlessly work towards sustainment of the system. All systems, subsystems, resources, and the environment interact to implement data, integration, and adjustment. All parts impart and influence the other parts. Family therapist called this idea homeostasis.
  • During the beginning of systems theory, systems were considered to be closed using negative feedback notions, maintaining the homeostasis of the organization
  • Prominent Family Theorist
  • 1. Carl Whitaker 1948
  • Carl Whitaker is known to be one of the foremost theorists in the development of Family Therapy. He began his career as a physician/psychiatrist assigned by the U.S. government to work with the troops during war time. His approach was warm and fuzzy, hoping to get the client to deeper, emotional experiences. He was one of the first theorists in family therapy to utilize family treatment, the use of co therapy, and the support of a supportive partner assisted the therapist to battle counter transference (Nichols, 2010). His approach to therapy was eclectic, flexible, he made use of the term “the dance in the family”, and while many failed to comprehend his strategy or his approach to treatment, his approach always had an underlying method and content.
  • In 1946 Whitaker became chairman of the department of psychiatry at Emory University. He continued his treatment with family and schizophrenic families. His involvement in this treatment modality led to conferences held regularly, and eventually this led to the development of the family therapy movement. After these conferences began to meet regularly, providing a format for the discussion of work with family treatment, the use of one-way mirrors was instituted as a tool to assist the treatment team in the development of care plans for the treatment modality. Whitaker left Emory in 1955 to begin his own private practice in Atlanta, Georgia. He and other prominent therapist developed a treatment for family therapy that included individuals, couples, and group therapy.
  • 2. Gregory Bateson 1950
  • Gregory Bateson began his career in 1950 at the Palo Alto Group in Palo Alto, California. His original work involved a project with schizophrenics. Bateson was a scientist who had done work, mostly with animal subjects, in learning theory, evolution, ecology, and psychiatry. His book “Steps to an Ecology of Mind” reflects work he incorporated with the work of Margaret Mead, an anthropologist. This work led to his interest in cybernetics which he later incorporated with anthropology ideologies.
  • In 1962 Bateson shifted his interest to the study of communications. Beginning in 1952 a grant he had received from the Rockefeller Foundation allowed him the opportunity to work on a project that involved the levels of communication (Nichols, 2010). The different levels he studied included report (what is actually said), and command (covert, unnoticed, method of delivery) has come to be known as metacommunications. In 1954, Bateson began work with the communication of the schizophrenic with a grant from the Macy Foundation. He later surmised that the communication patterns in the family are based upon this feedback, and he defined this process as homeostasis to explain the symptomatic behavior in the family unit. Even later, in 1956, Bateson discussed his theory of the schizophrenic in the family unit; the communication process and the feedback in the family dialog which he called the double bind that was seen as pathological family communication.
  • Don Jackson 1957
  • In 1956 Don Jackson was writing, along with a colleague (Jay Haley), about the subject of the family marriage in relation to communication. As the topic of marital therapy evolved it was incorporated into the field of family therapy (Nichols, 2010). Jackson began to move away from his training in psychoanalysis and he began to focus his work upon the exchange between individuals who communicate, and the analysis of communication. He had, originally, developed a theory of basic family therapy in 1954. He used terms from biology, and systems theory to describe his theory of families defined as homeostatic bodies. This theory of homeostatic family units became known in the field of family therapy families that resist change, and it was used as a metaphor for the family in crises. Jackson also was involved in work with the family with schizophrenic symptoms; he defined these families as units who use the symptoms to preserve the family status.
  • Jackson moved away from the mentality of behavior to establish a theory of personal interaction. His new theory surmised that individuals in long-term relationships establish a set of patterns in their interactions which he called behavioral redundancy (in dyads, triads, or even, large groups). In addition, he concluded that the family unit did not make use of the full spectrum of a range of behavior that was available to act out in their relationships. Jackson believed that the manner in which the family behaved with one another was the root of the cause of the psychosis in the identified patient in their family. He, also, made use of the terms complimentary relationships and symmetrical relationships. In the former type of relationship the family is defined by how each person fits together with the others. In the latter type of relationship the unit is defined by rules of equality ad similarity. Jackson’s most prevalent work was intended to focus upon the language used between the family unit. Critics implied that his work focused too much upon the adults in the family leaving the children in the family unit to be neglected. In 1959 Don Jackson founded the Marital Research Institute (MRI).
  • 4. Murray Bowen 1955
    Murray Bowen was one of the founders of Family Therapy. In 1956 the courts were implementing the Object Relations theory to establish resolution for couples seeking dissolution of their marriage (Nichols, 2010). A psychiatrist, Bowen began his work with a specialty in schizophrenia. He also incorporated the theory of systems in his work that has developed and evolved into family therapy. Bowen began his career at the Menninger Clinic in 1946 when he began work with children diagnosed with schizophrenia and work with their mothers in conjunction. This led to the development of his term differentiation of the self involving autonomy, and the separation of thought and feelings. Bowen later moved to the NIMH where he hospitalized an entire family with a child presenting with schizophrenia. This project focused upon the mother-child symbiosis, the role of the father, and involving the role of a third party which he called the triangle (Nichols, 2010). Bowen left this project in 1959 to take a position as a professor of psychiatry at Georgetown Medical School.
    Bowen had become one of the first therapists to develop the concept of family therapy. Bowen developed large group sessions for the entire family housed in the hospital setting, and he coined the concept of open communication that would facilitate the process of therapy between the family, the client, and the staff. In addition, Bowen discussed the relevance of the family who pulls you into their stuff (undifferentiated family ego mass), making note of the importance of the therapist to remain neutral with an objective position. The family was encouraged to talk to the therapist and not to one another. This technique allowed the degree of emotion to subside, and it allowed the ease of listening to others without becoming reactive, or triangulating in a third party. Bowen is said to have distanced himself from his family of origin more particularly his parents who tended to triangulate him into their personal struggles. This led to his theory of the differentiation of the self (Nichols, 2010).
  • 5. Salvador Minuchin 1960
    Salvador Minuchin began work with family therapy among colleagues at Wiltwyck. He was described as Latin, provocative, with flair to make use of whatever it takes to get the family moving towards change. Although described as a provocative figure his methods of treatment were described as structural and simplistic. In early 1960 Minuchin began his career in family therapy. He came upon two patterns in families who presented with difficulties. He called these patterns the enmeshed family (tightly/extremely close undifferentiated boundaries), and the disengaged family (members with little connection, a good deal of isolation, on the peripherals). He believed that either/or form of the family connection or lack there of, failed to exhibit any clear lines/boundaries of authority; they either lacked leadership/hierarchy roles, or support/guidance. This lack of structure leads to problems in the family system. When the family system can establish the needed structure a change in the rules is called first order change. When the family attempts to establish a change in the rules but are faced with options and alternatives, this triangle will call for a second order change which would be a change in the family system itself.

  • Minuchin worked with these concepts while he worked with juvenile delinquents at the Wiltwyck School for Boys in New York. With the development of his new concepts in the family system he was offered a position at the Philadelphia Child Guidance Clinic in 1965 (Nichols, 2010). Jay Haley joined the center in 1967. The duo worked tirelessly to develop the center into one of the foremost for the family therapy movement at the time. Later Minuchin began work that would train local African American members of the community to become paraprofessionals in the field of family therapy. And in 1969 the center received a grant for a two-year program that would develop a highly successful approach to training for family therapy and family systems. Their methods included accommodating the family, joining with them, and then implementing a restructuring method for the family to disrupt the bad strategies in the system, defusing poor boundary systems, and loosing rigid boundary systems. Munichin left the Child Guidance Center in 1981 where he established his own family treatment center in New York. The center was named the Minuchin Center for the family. Here at his own facility he dedicated his work to training therapist form global locations, and fighting for social justice in the foster care/Child Welfare System.
  • These are the most prominent family therapists and family systems figures that we have studied up to this time. They have woven their ideas into the work that has allowed us (students of the university) to become more proficient in our work with the individual, the family unit, and groups of individuals who may be couples, and/or families.

 

  • II. BOWEN, MRI, STRUCTURAL AND STRATEGIC MODELS OF FAMILY THERAPY
  • A. Murray Bowen Systems Theory
  • Bowen was one of the founders of Family Therapy. A psychiatrist, Bowen began his work with a specialty in schizophrenia. He also incorporated his theory of systems in his work that has developed and evolved into family therapy. He became one of the first therapists to develop the concept of family therapy. Bowen developed large group sessions for the entire family housed in the hospital setting, and he coined the concept of open communication that would facilitate the process of therapy between the family, the client, and the staff. In addition, Bowen discussed the relevance of the family who pulls you into their stuff (undifferentiated family ego mass), making note of the importance of the therapist to remain neutral with an objective position. This technique allowed the degree of emotion to subside, and it allowed the ease of listening to others without becoming reactive, or triangulating in a third party. Bowen was said to have distanced himself from his own family of origin more particularly his parents who tended to triangulate him into their personal struggles. This led to his theory of the differentiation of the self (Nichols, 2010).
  • Bowen’s approach to therapy involved helping people to learn about themselves, and their relationships in an effort to encourage responsibility for better relationships. This responsibility allows individuals to take responsibility for their actions and their behaviors in the system of the unit. In sessions Bowen therapists join with the family, asking questions using the Family Therapy Model. This model assist the family (member) to identify their own role in the presenting problems, the familial difficulties, to get past blaming, scapegoating, and any naming of the identified patient. Each individual is encouraged to explore their role and their input in the system as it relates to other family members.
  • His exploration of role responsibility involves process and structure. Process involves the pattern of reactions of emotions. Structure involves the pattern that envelopes into a triangulation between three individuals, things, or entities (affairs, drugs, work). The husband and wife usually initiate the triangulation process with the other. The therapist enacts a new triangle with the couple while remaining emotionally neutral. The process begins with detriangulation and differentiation of each person to change the face of the family system. This process is facilitated by the therapist who allows for the parent/couple the ability to face the self, to experience their own anxiety that has contributed to this new responsibility, which also allows for better parenting for their child (ren). In addition, the couple becomes better partners through increased emotional functioning and decreased episodes of anxiety in the system.
  • Murray Bowen’s focus was mainly on the family of origin. However, second generation Bowen therapists focuses upon the nuclear family to enhance functioning in the family. Bowen, also, focused upon acknowledging the difference between feeling, thinking, and learning in the systems approach in the resolution of problems. His primary focus takes the position that family members in their relationships be able to lower their anxiety levels, increase self focus to face the self and their contribution to the relationship difficulties, that will implement a change in the functioning of the family system. This differentiation process extends to better relationships with extended family, and it will extend the emotional energy for the person. This concept parallels Freud’s theory of the mind (Nichols, 2010).
  • Bowenian therapy goes beyond the use of detriangulation. The model uses other (tools) to implement the assessment process for the family. In sessions the therapist may use genograms, process questions, coaching, and displacement stories. The therapist begins by taking a history of the family and their presenting problem in relation to how the problem came into existence. In addition, the therapist will take a history of the family members beginning with the parent/couple. There will be an exploration of their courtship, their own family of origin as well as their birth position in their family, and the story of the function of their own parent relationship. The therapist will attempt to capture an understanding of how the family system has functioned in the past, as well as how it functions in the here and now conditions. The process question explores the interminglings of people; between people as well as the internal emotional state. Bowen utilized his treatment with couples/parents, as well as with individuals. His work with the individual was used to encourage the impact of change in the family system.
  • B. MRI Model
  • In 1959 Don Jackson founded the Mental Research Institute (MRI). This strategic model of treatment was one of three strategic models of treatment; (MRI, Brief Therapy, Family Therapy). The MRI strategic model espoused that family problems are the result of improper management of ordinary day to day life experiences and difficulties. This mismanagement of problems leads to people who get “stuck” in a more of the same, duplication of their efforts over and again to resolve their difficult moments. The Milan Group, from Milan, Italy (Palazzoli, Boscolo, Cecchin and Prata 1978) later incorporated this model’s original ideas of the double-bind to establish their own treatment model.
  • The MRI strategic model explored the concept of cybernetics, negative feedback, metaphors, as well as how the family regulates their unit system. The goal of therapy was intended to disrupt the interactions that involved the negative, circular feedback process that proceeded to maintain the family process, developing into the symptoms of the family. A few years later the staff leaned towards an interest in the clinical work of pragmatic, problem solving approach that began with Milton Erickson. Erickson, along with his colleagues (Haley, Weakland, Bodin, Watzlawick) developed a brief therapy treatment model. This model sought to identify the vicious cycle of disruption, to interrupt the cycle that disrupts solving of problems, increasing the existence of the difficulties.
  • Don Jackson’s theory of the family system surmised that individuals in long-term relationships establish a set of patterns in their interactions which he called behavioral redundancy (in dyads, triads, or even large groups). In addition, he concluded that the family unit did not make use of the full spectrum of a range of behavior that was available to act out in their relationships. Jackson believed that the manner in which the family behaved with one another was the root of the cause of the psychosis in the identified patient in their family. Jackson made use of the terms complimentary relationships and symmetrical relationships. In the former type of relationship the family is defined by how each person fits together with the others. In the latter type of relationship the unit is defined by rules of equality ad similarity. Jackson’s most prevalent work was intended to focus upon the language used between the family unit. His critics implied that his work focused too much upon the adults in the family leaving the children in the family system to be neglected (Nichols, 2010).
  • In this theory of communication methods in the family and the MRI approach the model was built upon a six step treatment implementation; 1. Introduce the set-up, 2. Inquiry and define the problem, 3. Establish the behavior identified in the problem, 4. Establish the goals of treatment, 5. Select and implement behavioral interventions, and 6. Termination of the treatment. At this point the therapist engages the family to determine the major point of difficulty. Vague expressions, or inconsistent proclamations will encourage the therapist to hone in on the miracle question “what will be the one thing to make it all better?” The therapist moves on to determine and to identify the family’s use of their resolution of difficulties that may result in maintenance of the problem. It was determined that the perpetration of difficulties in the family depend upon either 1. Denying the problem; no action is taken, 2. Solution attempts to resolve something other than the real issue; action is taken when none is required, and 3. The solution is attempted that will impede any progress; action is taken at the wrong level (Nichols, 2010).
  • MRI therapists will develop a strategy that will intervene in the presenting problem- maintenance sequence. The family is encouraged to implement this strategy by the use of

reframing the problem to increase the likelihood of a change in the process. The therapist also makes use of paradoxical intervention to interrupt the sequence of problem-maintenance. This technique encourages doing something that is the exact opposite of common sense methods. There are even times when the therapist’s hope is that the client will rebel his directives in an effort to reverse the pattern of failed resolutions, or to expose the family’s efforts in colluding to continue the difficulties (Nichols, 2010).

  • The MRI therapist takes a one-down position, avoiding any directive or power struggles. This is a position of equality with the family, in addition to an effort to reduce levels of anxiety and/or resistance. When the family is capable of acknowledging the patterns of maintaining the problems, the established sequences, and the negative feedback that results in symptoms in the family, the therapist will facilitate the process of change in the family unit.
  • C. Structural Family Model 1970-1985
  • The Structural Family Therapy model had a double divide. First, the therapist works hard at joining and aligning with the family. Therapy aims to accommodate the family, to understand the family, with the goal of acceptance, and participation in the treatment process. When the therapist has joined with the family efforts are made towards using restructuring techniques. These techniques work to disrupt the destructive and dysfunctional system/subsystems in the family. Instead, they strengthen the weak ill-defined, diffuse boundaries that support the family, as well as the rigid unattended boundaries that have become part of the family functioning in the familial relationships. It is a simple method to work with family organization with easy 1-2-3 methods of treatment. For this reason many people wanted to partake in the training provided by the Child Guidance Center in Philadelphia (CGC).
  • Salvador Munuchin used his provocative flair to use whatever it takes to get the family moving towards change. He has been described as structural and simplistic. He began his work with family therapy in 1960. Soon he discovered two patterns in the family with difficulties; enmeshed (tightly/extremely close undifferentiated boundaries) and the disengaged family (members of the family have little connection, a good deal of isolation, are on the peripherals). He believed that either form of the family connection, or lack thereof failed to exhibit any clear lines/boundaries of authority; that either lacked leadership/hierarchy roles, or support/guidance. This lack of structure leads to problems in the family system. When the family system can establish the needed structure a change in the rules is called first order change. When the family attempts to establish a change in the rules but are faced with options and alternatives, this change will call for a second order change which would be a change in the family system.
  • Munuchin,, along with his colleague, at the CGC, Jay Haley made use of techniques that included accommodating the family, joining with the family, and then implementing a restructuring method for the family to disrupt the bad strategies in the system, defusing poor boundary systems, and loosing rigid boundary systems.
  • D. Strategic Family Model 1980
  • The Strategic Family Therapy model had a triple divide. This model was utilized in the MRI brief therapy group, with Jay Haley and Cloe Madnes, codirectors of the Family Therapy Institute in Washington, D.C., and with the Milan Group in Milan Italy. The leader of this model was the legendary Milton Erickson who was enamored post- humously. These therapists sought to imitate Erickson’s techniques, usually failing to grasp the important principles upon which he based his principles. It has been said (Nichols, 2010) that the “supreme artist” of this model were Munuchin, Milton Erickson, and Michael White.
  • Jay Haley entered the profession with a background in communications, and without the credential for clinical therapy work (Nichols, 2010). He made use of directive techniques that aimed towards control of others, without their consent, and without having to convince them that “this is good/best for you,” as well as the right thing for you to do. These behaviors that are exhibited often indicate the process within the family unit. In addition Haley emphasized the importance of the hierarchy (parents/husband/wife) in the family unit. He theorized that therapy should begin well in order for it to end well. This encouraged him to attend to the opening moments of the treatment process.
  • Jay Haley’s method of treatment involved the interviews with the entire family for the initial interview (as many as possible; even grandparents). He then went into four stages of the interview; 1. Social stage, 2. Problem stage, 3. Interaction stage, and 4. Goal-setting stage. In the social stage efforts were made to help the family to relax, and to feel comfortable. The next step worked towards getting each family member’s perspective of the family problem, starting with engaging the father. None of the other family members are allowed to interrupt the conversation while an individual is engaged with the therapist and speaking about their problem. During the disclosure Haley would observe to determine any patterns, clues, and the hierarchy role in the family. He avoided any feedback that might impact the process of the disclosures.
  • In the interactional stage of the model the family is allowed to discuss their view of the disclosure while the therapist observes. Haley used this time to look for the strength of the hierarchy as well as for any developed coalitions in the family. Haley would give the family tasks, and homework assignments in an effort towards problem solving. The uniqueness of Haley’s theory was his thought that people get a “pay-off” from their symptoms (Nichols, 2010), that become the evidence of the struggles of relations in the family. He espoused that people have symptoms that cause the “drama”; that solutions can be found and developed to allow the family new ways to communicate, love, and work through their difficult moments. Haley, also, believed there could be up to 22 subsystems in the family depending upon the hierarchy of the family Structure (Haley, 1976). The goal-setting stage of his treatment was work to be done to work towards change in the family interaction, and towards termination of treatment.
  • These models have, also, woven their ideas into the work that has allowed us (students in the university setting/clicians) to become more proficient in our work with the individual the family unit, and with groups of individuals who may present to treatment as couples, and/or families seeking support.
  • E . Gurman’s Theory of Systems Model, Cybernetic, and Communication
  • Alan S Gurman (4th ed., 2008) argues that systems theory can present a number of difficult challenges. The structural approach used by Slavador Minuchin is appealing but still has its disadvantages. Minuchin’s technique, multipartiality, makes use of aligning oneself with one or the other of the family/couple at different times throughout the therapy session. There are frequent amounts of attempts to do so and the process requires much skill and flexibility on the part of the therapist tracking responses/behaviors/interactions(Gurman, 2008). In addition the process requires a good amount of concentration, while preventing relationship ruptures/fractures, while at the same time preventing individual feelings of being attacked, or taking sides. Should the therapist have multiple clients, and he/she is using similar strategies it can prove to be tedious and relentless. This application of back and forth joining, also, assumes that the client has the intellect and the insight to comprehend the tools that the therapist chooses to use in this process of connection for change. In addition, if not careful, and if the therapist fails to be quick to acknowledge his/her intentions he/she risks premature termination of services by the client.
  • If the therapist (using the systems theory of structure) chooses to make no alliance at all, but chooses the couple/family goals as the work platform this is considered absolute neutrality (Gurman, 2008). The intent of this technique maintains focus on effect of treatment as well as on the presenting problem. Critical information can be overlooked when the couple discloses information that is not questioned or debated. This can be contra-effective should the family present, also, with communication challenges. These challenges could be a rouse for more intense difficulties (substance use/abuse, mental illness, or domestic violence [DV]) involved with the family. This position of not taking alliances presumes that treatment is value-free. “This assumption may be appealing to social constructionist and narrative therapists, but we contend, as have others, that value-free practice is difficult, if not impossible to achieve (Gurman, 2008, p. 704).”
  • When possible, scenarios could prevent therapeutic neutrality the therapist should be on notice. 

Any family involved in child abuse/neglect concerns will need to be reported to the proper authorities (DCFS). This may cause a rift in the treatment alliance, which could also be inevitable. In addition, should there be cause to pause over issues of DV (cycle of power and control) therapy may approach an impasse. While there are therapists who recommend treatment for abusive spouses (Integrative therapy) the therapist is required to act in the best interest of the victim.

  • III. EXPERIENTIAL, MILAN, SOLUTION-FOCUSED, AND NARRATIVE MODELS OF THERAPY
  • A. Experiential Model of therapy
  • The experiential model of therapy developed as an extension of psychology and the focus upon the here-and-now experience for the client. In the early development of family therapy the intervention therapy moved past and beyond the theory of systems in families. The approach of the experiential theory was upon the emotional experience of the individual; their feelings in relation to the family. Virginia Satir and Carl Whitaker are the forerunners in this theory of development. Virginia used sculpting, feeling/touching and affirmation to encourage family interaction. Carl Whitaker made use of provocation, psychotherapy and novel techniques to encourage family interaction. The basis of this theory is that suppressed feelings and emotions have caused an impasse in family communications which develop into family stressors and family problems. The therapy encourages family members to tap into those suppressed emotions (inside, internal), and to work towards more comfortable family connections that help the family towards better functioning roles.
  • Carl Whitaker took away the idea of the therapist’s use of theory. He believed that the use of theory was for “beginners (Nichols, 2010)”; that the therapist should work with the goodness of being yourself in the relationship with the client. Experiential family therapy, however, evolved from existential-human treatment (Nichols, 2010). Whitaker’s approach espouses that the family becomes cohesive once family members have established their own sense of fulfillment. The position taken by Virginia Satir is that the individual in the family should look inward towards their own identified feelings, and express/communicate those real, and true feelings to their family. This would develop into a more genuine, cohesive family unit. The focus of this theory is less upon the family and more upon individual family members becoming more introspective, more flexible, ad establishing communication that facilitates family development.
  • The theory explains the development of problems for the family which begin to occur when there is a breakdown in the process of self actualization for the individual. Family members begin to deny, repress, avoid, and control their feelings in efforts to placate the system. Their problem solving skills are often overlooked or placed so far removed from reality that communication and barriers to solutions are disrupted. The family begins to avoid what they would like to experience for what is a secure and safe thing to do. The theory makes use of the terms scapegoat (Whitaker), sharing experience (Satir), and emotional deadness (Satir). Satir tells the family “you don’t know what you don’t know (Satir, 1964).”
  • Experiential theory states that change for the family/individual begins with identification of expressions of, and experiencing true feelings. Family members must be willing to take risks, to take charge of their sense of agency/autonomy, angry feelings, and face themselves/their part in the development of the family difficulties; opening up to other members of the family. The therapist facilitates these breakthroughs by being supportive; anchoring the exposed feelings; emotions; repressed anxieties; and ensuring an encounter for the family. This encounter allows the therapist to join/align with the family members, to become encouraging, caring, and reflective of the disclosures. Together this intervention allows for more honest, intimate, and reciprocal experiences that change the face of the family relating, connections, and relationships. The power of and the connection of the therapist is the key to recovery for the family. The result of treatment for the family is that being self-absorbed, scape-goating, blaming, and avoidance are replaced with improved communication, improved autonomy, and a better family reality.
  • Virginia Satir used touch, supporting the self-esteem, and positive approaches as techniques to facilitate change. Carl Whitaker made use of the self, provocation, developing a picture of the family, and he sometimes used outrageous tactics as a way to shake things up and to shock the family into reality. There were times he would require the use of a co-therapist to absorb some of the process. In addition, Whitaker encouraged many family members towards movement in his sessions. Other therapists using this model make use of art therapy, play therapy, role play, and Gestalt therapy, and work with couples.
  • B. Milan Model Therapy
  • The Milan Model of therapy was developed in Milan, Italy. The group was developed by theorist (Selvini Palazzoli, Boscolo, Cecchin, and Prata) as a strategic model that celebrated the work of the MRI agency and the legendary Milton Erickson post-humously. They sought to imitate Erickson’s techniques, usually failing to grasp the important principles upon which Erickson based his principles (according to critics). This model made use of the “therapy teams”, of co-therapists, two-way mirrors observation of the family, and consultation between the team and the therapist. The approach implemented five sections;
  • 1.) pre-session
  • 2.) the session
  • 3.) the inter session
  • 4.) the intervention
  • 5.) and the post-session discussion (Nichols, 2010).
  • During the pre session the team developed a hypothesis about the family. The hypothesis was based upon data gathered over the phone, from data sheets about the presenting problem, and interview notes. In the interview session with the family the team/therapist would change, modify or validate the initial hypothesis. The team would break the interview session after 40 minutes. They would then collaborate and establish interventions to use with the family. The therapist meets, again, with the family. At this time effort is placed upon the hypothesis, participation in rituals, homework assignments, and positively reflecting upon the presenting problem. Lastly, the team meets for the post session for a discussion to analyze the session and the family interaction, as well as to plan for the next session. Years of work and research led the team to establish three indispensible principles of the interview:
  • 1.) hypothesizing
  • 2.) circularity 
  • 3.) and neutrality (Nichols, 2010).
  • The therapist develops an initial hypothesis. If it is incorrect the therapist will develop a second hypothesis regarding the family. This is based upon testing of the initial starting point. The hypothesis is thought to be neither true or false but more or less useful for treatment and as a guide for treatment. In addition, the hypothesis serves a function of tracking data in the interview which confirms, disputes, or modifies the hypothesis. This tracking avoids possible, unexpected derailments or disorder in the session. This theory identifies any disorganization, refusal to establish patterns and developing randomness as entropy. The less entropy, the lack of information and the theory insist that the hypothesis be systemic. The therapist facilitates change by establishing order, guiding the process, uses provocation, and regulating interruption in the family or causing meaningless.
  • Circularity involves the therapist’s use of the hypothesis, investigating the premise with feedback from the family, and working towards change. The therapist is seeking the internal levels of truth involved in the dyad relationship. Simultaneously the therapist is seeking the broadness of the reality in observation. The interview delves into any connections with subgroups to the family, the family of origin (FOO), and peripheral/disengaged family members to establish a broad picture of family functioning.
  • Neutrality involves the behavior of the therapist that does not include the intra psychic self. The therapist solicits information from the family about their impressions of him/her, remembering not to take sides, being aligned with all family members, but with none of them at the same time (Salvini et. al, Mch, 1980).
  • The Milan Model uses a positive connection as an intervention towards change in the family. Therapy makes use of reframing the problem unity (“don’t change, stay the same’). Rituals allow the family to counter balance by engaging the family to act in ways that are counter to, and an exaggeration of, or novel ways to approach rigidity in the family.
  • In the 1990’s Palazzoli removed short-term strategic therapy from the model and included long-term therapy for individuals and families. This psychodynamic method utilized patterns in families, and insight, generational cycles, and family secrets. The focus here was upon the interview process. Cecchin and Boscolo determined that the use of the circular questions could be useful; striving for a certain outcome because the client is constrained. If used with genuineness, curiosity, and joining with the family regarding their problems an environment develops that establishes an epiphany for the client regarding their difficulties.
  • C. Solution-Focused Theory
  • This theory of therapy draws from the client’s here and now rather than from their past, or psychodynamic approaches. There is no supposition of any cause for the presenting problem. This theory has strong beliefs in the efficacy of humans. This belief espouses that people possess the ability to behave in competent and effective ways, but, that their ability to perform and behave in this manner has been compromised and impacted by constraints. The treatment model works to change the focus of the individual from the negative aspects of life; what have gotten into their unconscious minds causing their release, and jettisoning their actions, their thoughts, and their behaviors towards their capabilities. The client is viewed as being preoccupied with their problems because the problems always seem to have a presence. The client fails to recognize being free of the problem for any period of time. The theory works to reframe the problem moments for the client. They are encouraged to look for the exceptional times when the problem does not occur. The exceptions become solutions to the presenting problem.
  • Steve DeShazer and his wife Insoo Kim Beng were the primary anchors of this theory. The theory has been used with victims of trauma, abuse, and domestic violence. The model places an emphasis on the future rather than the past for the resolution of client struggles and difficulties. In addition, the model takes the lead, from the MRI theory, in their approach that defines problems as narrow views of constraints; which perpetrate negative and rigid patterns of behavior. There is an assumption that the client seeks change. When the model incorporates the theories of the MRI group, people are seen to only need a nudge towards a shift in their frame of reference to embrace their capacities. The client is encouraged to speak differently about their challenging moments. Problems delineate negatively, change embraces positivity. The use of well-focused goals and exceptions makes an impact for the family.
  • The model considers the client to be able to navigate through their own life well. The client is able to identify the challenges that constrain them, and they are best able to identify their needs. Asking the client if they can identify what they need, what you should ask them, or what they should tell you is a technique used to allow the client to put a name on the face of the challenges. It allows the client to become the expert of their own domain. Problems are part of growth, human development, and the life cycle. The client is resilient, and capable of adapting to new solutions that can improve their life. The family is a normal function unit with developmental struggles that can be adjusted towards their own individual way of the good life as quickly as possible.
  • This model encourages the client to find solutions that they already have the ability to access. Communication and language skills are used as a form of negotiation. The therapist should allow the client to talk in positive ways. This can reinforce positive thought processes, and to establish solutions to their constraints. The therapist facilitates the movement of positive strengths into the prevalent ones, and brings them out from the back drop. The client can then build on success, and then upon more success. Step by step the client is able to see their personal strengths, their capacity for improvement, and move towards believing in their own sense of agency to overcome other personal conflict.
  • D. Narrative Family Therapy
  • This model is used to construct new meaning to the life of the individual. There is less focus upon the behavior of the individual and more upon the meaning to one’s life. There seems to be a divide between what the individual experiences, and the ambiguity of the realness of the experience. The theory focuses on the organization of the process, giving it a name/title, and providing a level of importance to each. This allows for numerous interpretations, and multiple ways to embrace life situations. The therapist takes the position that if the interpretation does not go well with what the client perceives of the self, the interpretation is fruitless. This metaphor is called self-defeating cognitions—what people tell themselves about themselves. The job of the therapist is to help the client to broaden their scope of thoughts, and to move toward alternate thoughts and alternate approaches to their problems. Their stories about their life shape the direction of their life. The therapist should be encouraged to take small steps in this approach to resist failure and to assist the client in facing themselves.
  • Michael White is the founder of narrative therapy. His theory proposes to draw from his work in mechanical drafting, and the analysis of machines. His work took on a change and he later embraced the theories of Gregory Bateson. White moved towards Bateson’s theory of how people see the world that they live in. He was also influenced by the work of Frenchman Foucault. Foucault’s work orbited his theory into the belief that problems are things that impact people as opposed to things that people do (Nichols, 2010). Later David Epston joined the model group. Epston added that through his studies of anthropology the narrative approach seemed more applicable than cybernetics, and more of an approach to telling a story.
  • Epston facilitates encouraging self-help groups for the client towards recovery. In addition, he suggested that the therapist write letters to the client that the client can read to themselves long after therapy has terminated. The hope of this technique is that the letters will foster new hope and new perspectives. Narrative therapy has roots in psychotherapy, psychoanalysis, and the free association used by Sigmund Freud. The concept of missed opportunities and misunderstanding has its underpinnings in the theory of the unconscious. In the 1980’s there was a shift of this theory involving capturing the past to determine our reality to using the intellect of one’s narrative story. The therapist’s position was one of discovering the story that propels the client’s perceptions, filters, triggers and screens that create the reality for the client.
  • The therapist views the reality of the problem as the client’s view from their cultural frame that defines them as not being good enough. The therapist works to help the client to look at successful moments, while treating the client as a unique entity. The work involves avoiding the use of labels, and assisting the client to separate from their cultural view point to establish their own possibilities in their environment. Problems are externalized, and the client is encouraged to see themselves as fighting against the constraints; “the problem is the problem (Nichols, 2010, p. 351).” The therapist’s focus is, therefore, seen as how the problem impacts the family. Foucault influenced White to work towards the concept that personal narratives can be constructed and then deconstructed. Therapisst should avoid any labels regarding the client being normal, or of making categories of people; regarding what causes problems or what resolves the problem. Once the therapist has assisted the client to reconstruct those stories that are not working for them, they are to create new stories that are productive, and optimistic experiences that the individual is able to separate the self from their constraints. The problem is externalized, the problem is redefined, and the client can move forward. The process allows the client to see life through a new set of lenses; the shift has been successful, and people go from trying to satisfy the others to establishing their own paint strokes.
  • E. Personal analysis of the models
  • I have worked with individuals, and families in the capacity as a change agent for many years. In the past I often wondered about the process of change for the individual as well as for the family. I wondered why it seemed to be so difficult for them to see that their constraints were not making any allowances for personal growth or for the fusion of boundaries in the family system; the system was not working for them why not find a way to change the system?
  • Studying these theories and the models for change in the system, for the family and the individual provides the reader with different ways to observe, dissect, and explain struggles within the family and how one might approach the system for change. Each of these theories draw from theories of psychoanalysis and Sigmund Freud, the medical model of diagnosis and treatment for a cure, and providing an explanation of how to fix it. It appears that each of the theories takes from the other theories having added their own personal slant to the concept. The more things change the more they stay the same. The use of a different language, or a new style of writing, and communicating the theory makes a good impression on the profession of social work that strives towards innovation of treatment for the client.
  • Be that as it may, I believe that each of the separate models encourages the reader to reflect on the client that comes to their office in a difficult moment in their life. Theory helps the therapist to expand their perspective to develop treatment for the client, it allows us to develop strategy for treatment and techniques, and it reminds us that pain is real. Pain may come in the form of emotions, behaviors, relationships that fail/fractured relationships, and hopes for our life. What the client is experiencing is part of his real world and his reality for now, and maybe the recent and distant past. As a therapist we are to recognize that the client is seeking solutions to their difficult challenges in life, and hope that the pain can go away or at least to subside. I hope to be able to facilitate the process in the clinical milieu that will allow me to better facilitate the process of change for the client; helping them to release the rigid constraints that bind them into a challenging experience; releasing them into a life that is full with joy and multiple possibilities.
  • F. Gurman’s Theory on Experimental, Milan, Solution-Focused, and Narrative Models
  • Alan S. Gurman (4th ed., 2008) says of Solution-Focused Therapy (SFT), “although there is a theory-based, teachable model with specific techniques…the essence of SFT is an overarching worldview, a way of thinking and being, not a set of clinical operations (p. 259).” Gurman call the treatment a post-structural revision, non-normative, social constructionist reality that makes good use of language. Gurman summarizes that this theory gives much credit to the model for respecting personal resources, and creating solutions, insight and the lack there of fails to work towards psychological functioning. SFT meets the client where they are, it is client centered, and it respects the person, family and society.
  • Gurman’s view of SFT goes on to say that the initial intent of the model was to be indirective; it looked at the past prior to the resolution of their problems. Once resolution had been discovered the client is encouraged to do more of the same; if it does not work, don’t give it motion. The down side of this model is that it may appear that treatment solutions do not seem to have any connection to problems; it tends to lose its relevance in translation. The client determines then a point of termination of services. Critics of the model believe that client emotions are ignored or down played. That marginalizes groups (women, diverse groups) and it fails to address their pertinent issues unless they choose to have a voice (Gurman, 2008).
  • Narrative therapy can go on for years (Gurman, 2008) The model seeks to encourage family members to subvert the business as usual way of trying to measure up to others, or the norms of standard. Therapists come equipped with our own opinions, life experiences, and personal biases. When the client poses a scenario that is objectionable to any of these positions we may have we lead with questions that will elicit the presenting problems and to take a position (Gurman, 2008, p. 232). As the result of a non-subscribed and varied idea of healthy familial relationships, our assessments may evolve into tentative inferences. Therapists must remember these may have been countless day-to-day occurrences over time for the client. What we hear in treatment is a condensed form of what has been giving meaning for the client (Gurman, 2008).
  • The Experiential model is in the family of Emotional Focused Therapy (EFT). A present-focused treatment it only collects a small amount of relationship history in the assessment (Gurman, 2008). If the therapist should discover ongoing physical abuse the treatment is disrupted. Treatment is not allowed to continue until the abused partner is no longer feels unsafe. The abuser is encouraged to enter treatment, and the victim is encouraged to seek the support from additional treatment. This back and forth, disruption, begin, stall and begin again can add further complications to an otherwise unstable relationship (Gurman, 2008). First, self report is unreliable, and/or tenuous at best. Fear experienced by the victim may prevent disclosures of serious incidents. In addition, the abuser may attend treatment merely as a compliant going through the motions. This does not allow the abuser to gain any significant insight into his feelings and emotions.
  • “Change in EFT is not seen in terms of the attainment of cognitive insight, problem –solving or ventilation. The EFT therapist walks with each partner to the leading edge of the experience and expands this experience to include marginalized or hardly synthesized elements that give new meaning to the experience (Gurman, 2008, p. 123).” EFT seems capable of being applied and used for multiple populations; depressed, trauma, attachment disorder, and DV. Inexperienced therapists will need to tread lightly and learn to stay focused, and avoid personal biases. It cannot be stressed enough that the inexperienced therapist should seek support and/or supervision to explore those difficult moments (Gurman, 2008).

 

  • IV. A. Cognitive Behavioral Therapy (CBT) Model
  • Behavioral therapy was initially developed as a technique to use to teach couples communication skills, to teach parenting skills, and behavior modification. The treatment was anchored in academic settings, and primarily removed from mainstream family treatment. Descending from old European models of treatment the therapy model was initiated by Ivan Pavlov a Russian physiologist. Pavlov worked on reflex conditioning which was called classical conditioning. This conditioning model consisted of unconditional stimulus (UCS) and conditional response (UCR). In 1948 Joseph Wolpe established systematic desentization to work with phobias. At the University of Oregon Gerald Patterson was a figure head for behavioral parent training and the social learning theory. This treatment focused on eliminating undesirable behaviors and encouraging desirable behaviors.
  • In 1969 Richard Stewart established the contingency contract for behavioral family therapy. His model focused on behaving in positive ways which can be increased with the use of reinforcement reciprocity. In 1970 behavioral family therapy embraced parent training, behavioral couples’ therapy, and sex therapy. Robert Lieberman researched and wrote about behavioral approaches-using operant learning, role rehearsal, modeling behavior, as well as contingency management of mutual reinforcers (Nichols, 2010).
  • CBT was initially seen as a linear approach to treatment. It has been used as a treatment model for Family Therapy. The theory-model extrapolates from linear to circular. Behavior is maintained by consequences; behavior that exacerbates, you use reinforcers; when behavior is intended to de-esculate, you use punitive measures. This strategy is based upon the premise that people strive to maintain rewards. Once the undesireable behavior is gone, it is in extinction. The model came to recognize that people think, feel, and act. What we perceive of others behavior determines how we respond to them (Nichols, 2010). These core beliefs, and schemas reflect our world view, including any automatic thoughts (distortions, inferences).
  • CBT has underpinnings in the belief that in good relationships people work to have good experiences; in bad relationships the focus is upon the self, and self protection rather than what is good for the relationship. The behavior exchange theory states that the give and take positions are balanced. In 1978 Weiss and Isaac stated that the most important factors in marital bliss are communication, child care, and affection. This is influenced by lofty positive exchange and minimized unpleasantries. Behaviorists believe that symptoms are learned responses (Nichols, 2010). There is no effort placed on cause-effect but rather on looking for responses that reinforce problematic behavior. Oftentimes the problem behaviors are not only inadvertently reinforced; they cause the distress in their connection to others. Behaviorists believe those schemas develop in the growing up years in the family of origin. They further malign with distortions and responses to other’s behaviors (Nichols, 2008).
  • CBT seeks to modify specific behavior patterns to dissipate the presenting problem. Treatment is tailored to fit the circumstance working towards the extinctions of undesireable behaviors. The therapist works to find the patterns that connect and find ways to explain these connections. Methods are geared towards getting to the core belief and begin to challenge these beliefs, accelerating positive behavior. The therapist’s role includes teaching communication skills, negotiation skills, and problem solving skills. The therapist works to identify the stage development of the family, the family rules (implicit and explicit0, and how conflict is resolved for the members. Once the need for

change, acknowledgement of the need for change, as well as the tools that will be used for change are solidified, work begins to challenge the change. In addition the therapist seeks to exacerbate the change, to modify behavior, and to structure any belief distortions through the education, and facilitation process.

  • B. Gurman’s Theory of CBT Model
  • The primary aim of this model is to educate the couple to use effective communication in their relationship. “We believe that couples need to be taught more than specific guidelines…therapists who implement behavioral interventions, skills training, in a rote, simplistic manner fail to individualize these interventions (Gurman, 2008, p. 58).” Beginning CBT therapist may struggle with the concept of controlling the environment. This can result in a failure to regulate the emotional environment, assignment of homework tasks, management of the sessions, as well as grappling with validating one partner more than the other (Gurman, 2008). “We find that CBT is least beneficial when it is viewed primarily as a set of skills to be taught to couples in a routine manner, without sufficient thought to the uniqueness of each couple (Gurman, 2008, p. 59).” The CBT therapist must use a good balance of education, management, focus, and not take sides in the couple relationship.
  • V. Personal Model of Therapy; an Integrated Model
  • A. In 1974 I became a graduate of Purdue university in West Lafayette, Indiana. I proudly walked across the stage to receive my BA Degree in Psychology/Humanities. I was accepted into the MA program for the graduate program in Counseling at Purdue at the Hammond, Indiana campus. The prominent theories that were studied in the program were psychoanalysis regarding Sigmund Freud, and Client Centered Therapy regarding Carl Rogers.
  • Psychoanalysis Theory introduced me to more in-depth information about the id (I Do), the ego (I am), and the superego (I should), along with principles of hysteria, the oedipal complex, and free association. The theory base allowed the therapist to engage in individual sessions with patients, exploring their past relationships, guilt, the existence of the conscious, and the unconscious. Therapisst gave very little input to the client as the client disclosed intimate experiences with their family. The treatment was the most prevalent for the era. At that time I was working in Child Welfare services with a very poor economic population for my client base. I provided short-term counseling during home visits, office visits, and family meetings.
  • Client-centered theory introduced me to the spiritual, religion-based theory of Carl Rogers. This theory that embraced being genuine, reflective, and extremely patient with the client made me want to become a therapist. I found that in my work with clients in the public sector (Family and Child Services) I became more empathic, reflective in my listening skills, and worked to become an advocate for marginalized clients. I found this to be my method of providing services to others.
  • During the early 1990’s I lived in Evanston, Illinois, and enrolled in a PsYD program for psychology at the Forest Institute of Professional Psychology in Wheeling, Illinois. For three years I learned more background information about Sigmund Freud, Jung, Adler, H. S. Sullivan, J. Haley, Whitaker, DeShazer, Minuchin, Satir, and Bandura to name a few. I studied clinical skills, neuropsychology, psychopathology I, II, and III, and how to administer projective tests. I began to think more about working with clients using psychoanalysis, and projective/psychological tools to develop an assessment for better client services. As an employee of IDCFS the client base was typically subject to being evaluated psychologically if there was an open case for the family. My plan was to be an employee of the Department until my retirement. My client base included marginalized, poor economic status families involved in abuse and neglect. I was working in Child Welfare Services and providing short term counseling to families.
  • As my personal life derailed (marriage, children, divorce, work mandates) my professional style of treatment to the client evolved. I enrolled in a MA program in special education at NorthEastern University in Chicago, Illinois. I primarily studied education coursework in school. I continued to use psychoanalysis and short/brief counseling with my clients in the child Welfare agency. I was working, now, in Rockford, Illinois in Child Protection Investigations. Contact with the client was even more brief; a case was only assigned to me for 30 to 90 days before being transferred to the Child Welfare Services unit. Most of the work I did to provide counseling was with mothers of children, and during interviews with children in the family. After two years of course work at NE I relocated to Loves Park, Illinois. I returned to work in Child Protection Investigation and then to Child Welfare Services. My approach to counseling services with a regular case load of clients reverted back to the Rogerian approach to treatment with the client. I was working with clients with dual diagnosis mental illness, substance misuse, and abuse/neglect involvement with the Department. This population required a good deal of empathy, reciprocal empathy, and genuineness. These are the primary techniques uses with this model.
  • In 2000 I entered Aurora University in the MSW program for Social Work in Aurora, Illinois. The course work included policy, psychopathology, general practice, ethics, models of practice, and research. My work responsibilities changed at DCFS to work with intact families in Glen Ellyn, Illinois. The community is high income status for families (typically), with many cultural, and educational advantages for a suburb that is 35 miles west of Chicago, Illinois. Most of my work load involved adoptions, interstate placement of children, and stabilization services to children placed in the home with their parents. I began to use narrative therapy with the parent couple. This allowed the parents to better communicate under the Child Welfare and Court system; and it allowed the parents to have a voice in the system.
  • It seems that the model of treatment I used depended upon a number of factors. Meeting the client where they were involved making provisions for the community of the family, the economic status, and the division of services where my work placed me. In 2004 I was living in Dekalb, Illinois, working in Child Protection Investigation in the IDCFS office in Dekalb. Again, short term counseling was the most significant service that was provided to the parents of the children who were taken into protective custody. I found that narrative treatment allowed the parents to tell their story, and to make a connection with their partner or the peripheral parent in the home. It also allowed the parents to get in touch with establishing stability for the family.
  • I had been accepted (2004) in the Doctoral program for Counseling and Adult Education at Northern Illinois University (NIU) in Dekalb. The course work included policy, counseling, education, and independent research. The focus of the counseling program was Client Centered/ Rogerian therapy. When I had an opportunity to interview, counsel, and record my session with a client this was the course curriculum used to satisfy the course requirements. Most workers who have worked in DCFS for a number of years find themselves working in the Licensing unit. I began working in Day Care Licensing in 2006 in Rockford, Illinois. My work went from being very clinical work to almost no clinical basis for services. My client base consisted mostly of women who had retired from work and now had opened their own day care home or day care group home. Others were husband and wife who owned their own day care home. The children in this substitute care arrangement were primarily from private pay homes and therefore not connected (not wards of the state, not foster care children) with DCFS. These facilities are required by state law to be licensed by DCFS (if there are over three children in their substitute care in addition to their own children). The requirement is part of the Child Care Act of 1969. 
  • My work as a social worker had gone from having a model of treatment with the client base to having a client base that had changed from Rogerian, narrative, and strengths based models to short term counseling using effective listening skills, advocacy, and supportive interventions (corrective action plans for the facility). In 2012 I was accepted in the Doctoral program for social work at Aurora University in Aurora, Illinois. The course work has included social work history, social work philosophy, systems theories, psychology history, and clinical seminars. This has included more in depth coverage of attachment theory, narrative, DBT, couples, family, and individual therapy. In my preceptor field placement I worked for several months providing couples counseling to an African American male and his Caucasian female partner living in a homeless shelter. Their presenting problems were trans-gender teenager in the family, blended family, divorce, DMV, and communication difficulties. The male wanted me to “fix” his girlfriend so they would be able to have a better relationship.
  • Initially, I found I was using Bowen therapy, but I began to use narrative therapy to allow the partners to better understand the past history of the other. In this treatment I discovered a pattern of pursuer-distancer, when she began to become more vocal in the relationship, he began to decline in the relationship (walked out of sessions, became silent, seemed to be confused). I assured the coupled that I would not take sides with either partner, and I allowed the couple to meet with me in individual sessions (with the reminder that what was discussed in the session would be shared with the other partner). I found myself providing a good deal of education about life, family and relationships to the couple, more to the female. In addition, I spent a good deal of time assisting her to learn more about appropriate boundaries, and learning how to say and to do things differently in an effort to maintain a better relationship with her partner.
  • I find that although my ground work has been anchored in Freudian and Rogerian models of practice I have come to appreciate the benefits of integrating narrative treatment as well as Bowen therapy in my plan of care and the goal of treatment for the client.
  • B. My Model of Treatment would probably look something like this:
  • 1. Theory of Dysfunction: I have read that at least 7% of the population will improve their condition without therapy. The other 93% will enter treatment as either a customer or a complaint. Everyone who comes to treatment does so because of some other entity (parent, spouse, partner, community, court). Most of these individuals have not recognized that they have become stuck in life experiences, they have not been able to face the self or to recognize the self any more, and they have been the victim of those who have not allowed them to think outside of the box. This may include being pushed down in life experiences, and/ or not allowed the experience of enjoying their full potential.
  • 2. Theory of change: The client needs to learn how to “change the channel” of their life connections and life processes; to look in the mirror, and learn alternate ways to explore their environment.
  • 3. Role of the Therapist: the therapist will join with the client, make an alliance, and establish rapport with the client as quickly as possible. The therapist should not take sides with other partners of family members, but encourage the open participation of all who are involved; as many as who can attend the session(s). In addition the therapist will be warm, genuine, empathic, and explore the possibilities of using other models of treatment when applicable.
  • 4. Goal of treatment: everyone has the opportunity to explore their sense of agency, their autonomy, how they are able to navigate in their environment, what their resources are, and how to integrate their sense of self with their environment. The goal of treatment is to develop into the best you that you can be (client); learning tools and skills to facilitate the process.
  • 5. Techniques/tools to use: Narrative therapy, integrative therapy, object relations, psychodynamic model; early childhood therapy model; homework tasks.
  • IV. Critical analysis
  • The profession of social work parallels the evolution of developing societies. In the beginning there was very little knowledge about the world, life, relationships, and how to best meet the needs for oneself and those immediately connected to us. As time evolved, and knowledge became more available the world became more sophisticated, relationships in the family improved and families became more mobile. The profession of social work began with the pioneers who thought that they had the best intentions to help the poor to improve on their plight in life. The profession began to grow as they shared professional content with other professions in our society. Religion and Philosophy branched out into different academic venues that allowed the masses to become better educated and to improve their lives as well.
  • The field of social work has advanced as the result of a number of theorists who have had an idea, who took their ideas and extrapolated to higher advantages in the models of practice, and expanded our scope of data (through collaboration, as well as empirical work). The field has grown in leaps and bonds from the times of Mary Richmond and Jane Adams. But we, still, continue, to grow from advances in the field with more research, and further development.

 

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