AN
AN
INTRODUCTION
INTRODUCTION
TO
TO
FAMILY
FAMILY
THERAPY
THERAPY
Tags: Family Therapy - Practical Guide – Manual – Theory – Summary - Course – counselling – counsellor
Compiled
Title: An Introduction to Family Therapy Compiled by: Dean Amory
Dean_Amory@hotmail.com
Publisher: Edgard Adriaens, Belgium eddyadriaens@yahoo.com
ISBN: 978-1-291-38975-3
PUBLIC DOMAIN PUBLICATION
© Copyright 2013 Edgard Adriaens, Belgium, - All Rights Reserved.
This book has been compiled based on information that is freely accessible in the public domain on the internet. Whenever you cite such information or reproduce it in any form, please credit the source or check with author or editor.
If you are aware of a copyright ownership that I have not identified or credited, please contact me at: Dean_Amory@hotmail.com
Cover Illustration:
Zirta - Ilustrador, Diseñador, Historietista
Beatriz Torres, 1981, Tampico, México.
He dibujado historias toda mi vida. Estudié la carrera de Diseño Gráfico, pero mi verdadera pasión son los cómics. En 2001, mi amiga Shiaya y yo creamos HED: Hilando el Destino.
En 2006 propuse Oseano como tira cómica al diario La Razón de Tampico, donde lo publiqué diariamente hasta 2011.
Actualmente me desempeño como ilustradora freelance, y estoy trabajando en mi primera novela gráfica. Contacto: beatriz@zirta.net
Zirta - Illustrator, designer, cartoonist
I've drawn stories all my life. I studied Graphic Design, but my real passion is comics. In 2001, my friend Shiaya and I created HED: Spinning Destiny.
In 2006 I proposed the comic strip Oseano to the newspaper “La Razón de Tampico”, and published daily until 2011.
Preface
All information in this manual was collected for personal use from freely accessible sites on the internet, a lot of it was found in the free encyclopaedia Wikipedia.
The same applies to all pictures used, which I downloaded from public domain sites, with exception for the cover picture “la familia Dupont”, which was kindly made available to this purpose by its creator, Zirta (Beatriz Torres, Mexico).
Since I feel many people will benefit and appreciate being allowed to get easy access to this kind of information ordered in short, easily accessible chapters, I decided to make this compilation work available for free to everybody as a download file. A printed copy of the manual can be purchased at http://www.lulu.com (http://www.lulu.com/shop/various-authors/practical-manual-of-family-therapy/paperback/product-15478201.html)
Should any of the authors of the borrowed texts feel that the present manual is not compatible with the way in which they planned to make their work available to the public, then I hereby invite them to contact me at Dean_Amory@hotmail.com and let me know which part of the manual should be adapted or replaced by information from other sources.
Family Therapy – Contents
Cover Illustration:...5
Zirta - Ilustrador, Diseñador, Historietista ...5
Preface...7
Family Therapy – Contents...8
Family Therapy – Background Information ...23
History of Marital Therapy ...24
Phase I - 1930 to 1963 - Atheoretical...24
Phase II - 1931 to 1966 - Psychoanalytic Experimentation ...24
Phase III - 1963 to 1985 - Family Therapy Incorporates ...24
Phase IV - 1986 to now - Refining and Integrating ...24
History and theoretical frameworks ...25
Techniques ...27
Publications ...28
Licensing and degrees ...28
Values and ethics in family therapy ...28
Founders and key influences...29
Principal Leaders in the Field: ...29
Salvador Minuchin ...30
Jay Haley...30
Murray Bowen ...31
Nathan Ackerman...31
Virginia Satir...32
Ivan Boszmormenyi-Nagy ...32
John Elderkin Bell...33
Philip Guerin ...33
Don Jackson ...33
Carl Whitaker ...34
Betty Carter ...34
Michael White...35
Models and Schools ...36
Some contemporary family therapies: ...36
Structural Family Therapy (Minuchin, 1974, Colapinto, 1991) ...36
Conjoint Family Therapy (Satir, 1967)...36
Contextual Therapy (Boszormenyi-Nagy, 1991) ...36
Strategic Therapy (Madanes, 1981) ...36
Brief Therapy ...37
Milan Systemic Therapy (Boscolo et al, 1987)...37
Narrative Therapy (Freedman, Combs, 1996) ...37
Academic resources ...37
Professional Organizations...37
Useful Internet links...38
External links ...38
Brief Strategic Family Therapy ...39
Description ...39
Program background ...39
Indicated...39
Content focus ...39
Intervention by domain ...40
Parents as a primary target population:...40
Individual: ...40
Family : ...40
Peer :...40
Key program approaches...40
Parent-child interaction: ...40
Parent training: ...40
Skill development: ...40
Techniques used ...40
Therapy ...40
How it works ...40
There are four important BSFT steps:...41
Barriers and problems ...41
Brief Strategic Family Therapy for Adolescent Drug Abuse...42
Foreword ...42
Chapter 1 - Brief Strategic Family Therapy: An Overview...43
BSFT is based on three basic principles. ...43
Why Brief Strategic Family Therapy? ...44
What Are the Goals of Brief Strategic Family Therapy?...44
What Are the Most Common Problems Facing the Family of a Drug-Abusing Adolescent?...44
The Family Profile of a Drug-Abusing Adolescent ...45
The Behavioral Profile of a Drug-Abusing Adolescent...45
Negativity in the Family...45
What Is Not the Focus of Brief Strategic Family Therapy?...46
This Manual ...46
Chapter 2 - Basic Concepts of Brief Strategic Family Therapy...47
Context ...47
Family as Context ...47
Peers as Context ...47
Neighborhood as Context...47
Culture as Context...48
Counseling as Context...48
Systems ...48
A Whole Organism ...48
Family Systemic Influences ...48
The Principle of Complementarity...49
Strategy: The Three Ps of Effective Strategy...50
Content Versus Process: A Critical Distinction ...51
Chapter 3 - Diagnosing Family System Problems ...52
Leadership ...52
Subsystem Organization...52
Subsystem Membership ...52
Triangulation ...53
Communication Flow...53
Resonance ...53
Enmeshment and Disengagement ...53
Resonance and Culture...54
Enmeshment (high resonance) and Disengagement (low resonance)...54
Developmental Stages...54
Assessing Appropriate Developmental Functioning...55
Common Problems in Assessing Appropriateness of Developmental Stage...55
Life Context ...56
Antisocial Peers...56
Parent Support Systems and Social Resources ...56
Juvenile Justice System...56
Identified Patient ...56
Conflict Resolution ...57
A Caveat...58
Chapter 4 - Orchestrating Change...59
Establishing a Therapeutic Relationship...59
Joining ...59
A Cautionary Note: Family Secrets ...60
Tracking ...61
Encouraging the Family to Interact...61
Tracking Content and Process...61
Mimesis ...61
Building a Treatment Plan ...62
Enactment: Identifying Maladaptive Interactions ...62
Family Crises as Enactments ...62
A Cautionary Note: Adolescents Attending Therapy Sessions on Drugs...63
From Diagnosis to Planning...63
Producing Change ...63
Seven Frequently Used Restructuring Techniques ...64
1. Working in the present ...64
2. Reframing: Systemic Cognitive Restructuring ...64
Affect: Creating Opportunities for New Ways of Behaving...65
3. Reversals ...66
4. Working With Boundaries and Alliances ...66
Behavioral Contracting as a Strategy for Setting Limits for Both Parent and Adolescent ...67
Boundaries Between the Family and the Outside World ...67
5. Detriangulation...68
Attempts by the Family to Triangulate the Counselor ...68
6. Opening Up Closed Systems...69
7. Tasks ...69
Central Role ...69
General Rule...69
Chapter 5 - Engaging the Family Into Treatment ...70
The Problem ...70
Dealing With Resistance to Engagement...71
The Task of Coming to Treatment ...72
Joining ...72
Establishing a Therapeutic Alliance...73
Diagnosing the Interactions That Keep the Family From Coming Into Treatment ...73
Restructuring the Resistance ...74
Types of Resistant Families ...74
Powerful Identified Patient ...74
Contact Person Protecting Structure ...75
Disengaged Parent...76
Families With Secrets ...76
Chapter 6 - Clinical Research Supporting Brief Stategic Family Therapy ...77
Outpatient Brief Strategic Family Therapy Versus Outpatient Group Counseling ...77
Conduct Disorder. ...78
Association With Antisocial Peers...78
One Person Brief Strategic Family Therapy ...79
Brief Strategic Family Therapy Engagement...79
The six levels of engagement effort ...80
Efficacy of methods of engagement...80
References ...81
Solution focused brief therapy ...86
Contents...86
Basic Principles:...86
Questions...87
The miracle question ...87
Scaling Questions...88
Exception Seeking Questions...88
Coping questions...88
Problem-free talk...89
Resources ...89
History of Solution Focused Brief Therapy ...89
Solution-Focused counselling ...90
Solution-Focused consulting...90
References ...90
Brief (psycho-) therapy ...91
Founding proponents of Brief Therapy...91
An Overview of Brief Therapy ...93
The brief therapy solution-focused approach can be summed up in three stages,...93
Strategic Family Therapy...94
Haley Model...95
Behavior Problems ...95
Family Interaction ...95
Therapy ...95
Bowen’s Strategic Family Therapy ...98
Contents...98
Introduction ...98
The family system ...98
There are eight interlocking concepts in Dr. Bowen's theory: ...99
1)
Differentiation of self:...99
2)
Triangles:...99
3)
Nuclear family emotional system: ...99
4)
Family projection process: ...99
5)
Multigenerational transmission process:...99
6)
Emotional cut-off: ...99
7)
Sibling position: ...99
8)
Societal emotional process:...99
1. Differentiation of Self ...100
2. Triangles...103
3. The Nuclear Family Emotional Processes ...105
4. The Family Projection Process...108
5. The Multigenerational Transmission Process ...112
6. Sibling Position ...114
7. Emotional Cut-off ...116
8. Societal Emotional Processes...118
Areas of assessment ...120
1) Spousal relationships...120
2) De – Triangulation ...121
3) Differentiation Of The Self and Emotional Cutoff...122
4) Understanding family emotional systems...123
Normal Family Development...126
Family Disorders...126
Family Therapy with One Person ...126
Goals of Therapy...127
The practice of Bowen family therapy is governed by the following two goals: ...127
Treatment entails...127
More specifically, the therapist ...127
Techniques ...128
Other concepts:...128
More about Triangles ...129
1. Cross-generational coalitions ...129
2. The authors reviewed three family triangles:...129
3. The Emotionally Disturbed Child as the Family Scapegoat. ...130
4. Marks, S. (1989). Towards a systems theory of marital quality. ...131
seven different manifestations of the dual triangle construct...131
Criticisms on the triangle theory ...132
Salvador Minuchin’s Structural Family Therapy ...133
Contents...133
The family – homeostasis & change ...135
The presenting problem...136
The Process of Therapeutic Change...137
Therapeutic Goals and Techniques ...138
See also...138
References ...138
Definitions...139
Structure, subsystems and boundaries...139
Examples demonstrating boundaries and subsystems...139
Reaction to change: ...140
As with boundaries, hierarchies can be either be too rigid or too weak ...140
Salvador Minuchin’s Style...140
Family member behaviour can be understood only in the family context. ...141
Counselors must differentiate between first-order and second-order changes. ...141
Key concepts: ...141
Three reasons that make clients move: ...142
Conditions for behaviour change ...142
Four sources of family stress: ...142
Sets: ...142
Goals: ...142
How therapy addresses boundaries ...143
Interventions:...144
Assessment of therapy...144
Four steps identified by Minuchin and his colleagues. ...144
Therapy techniques : The seven steps of family therapy ...144
Step 1: joining and accommodating...144
Step 2: Enactment ...145
Step 3: structural mapping ...145
Step 4: highlighting and modifying interactions ...145
Step 5: boundary making ...145
Step 6: unbalancing ...145
Step 7: challenging unproductive assumptions ...146
Conclusion...146
Virginia Satir’s Humanistic Family Therapy...147
Key concepts: ...147
Turn roles into relationships, rules into guidelines. ...147
Interventions:...147
Criteria for termination: ...148
Behavioural & Conjoint Family Therapy...149
Matching intent and impact of communication. ...149
The four components in a family situation that are subject to change are...149
The three keys to Satir’s system are...149
Communication and Response Patterns ...150
The counseling method of conjoint family therapy involves...150
Games...150
The Counsellor’s Role...151
Milan Systemic Family Therapy or “Long Brief Therapy”...152
Key Concepts: ...152
Therapy: ...152
Interventions:...152
Assessment...153
Family Development through a systemic lens ...154
The process of change...155
Roadblocks to family developmental change ...157
Interventions that create a context for developmental change. ...157
Conclusion...158
Response-based Family Therapy ...159
Therapeutic Methods...159
References ...160
Related Reading ...160
Contextual Family Therapy Approach ...161
The core of Contextual Approach rests on two postulates...161
Four-Dimensional Interventions ...162
Facts ...162
Individual Psychology...162
Transactions ...163
Critics ...163
Entitlement ...164
References and Bibliography ...165
Narrative Family Therapy ...166
Contents...166
Overview ...166
Narrative therapy topics ...167
Concept ...167
Narrative approaches...167
Common elements...168
Method ...168
Outsider Witnesses...168
Definitions...170
The identified patient ...170
Homeostasis (Balance)...170
The extended family field. ...170
Differentiation ...170
Triangular relationships ...170
Multisystemic Therapy...170
Calibration:...170
Family Life Cycle: ...171
Centrifugal/centripetal: ...171
Circular (mutual, reciprocal) causality:...171
Cybernetics:...171
Double bind...171
Equifinality / Equipotentiality:...171
First-order / Second-order change:...171
Pseudo mutuality:...171
Punctuation:...172
Rules:...172
Criticisms of Narrative Therapy...172
See also...172
Theoretical foundations...172
Related types of therapy...172
Other related concepts...172
References ...172
We do not tell stories only: we are stories. ...173
Basic Techniques in Family Therapy ...174
OBSERVATION...174
IDENTIFICATION...174
I/ INFORMATION-GATHERING TECHNIQUES...175
GETTING INFORMATION THROUGH USING OPEN-ENDED QUESTIONS. ...175
THE GENOGRAM...175
THE FAMILY FLOORPLAN ...176
FAMILY PHOTOS...176
II/ JOINING ...177
1) TRACKING:...177
2) MIMESIS:...177
3) CONFIRMATION OF A FAMILY MEMBER: ...177
4) ACCOMMODATION:...177
III/ DIAGNOSING...177
IV/ FAMILY SYSTEM STRATEGIES ...178
ASKING PROCESS QUESTIONS. ...178
FAMILY SCULPTING ...178
FAMILY CHOREOGRAPHY...178
V/ INTERVENTION TECHNIQUES ...179
RELATIONSHIP EXPERIMENTS...179
COACHING...179
I-POSITIONS...179
DISPLACEMENT STORIES. ...179
TAKING SIDE & MEDIATING...180
THE EMPTY CHAIR ...180
FAMILY COUNCIL MEETINGS ...180
STRATEGIC ALLIANCES...180
PRESCRIBING INDECISION...180
PUTTING THE CLIENT IN CONTROL OF THE SYMPTOM...180
SPECIAL DAYS, MINI-VACATIONS, SPECIAL OUTINGS ...181
FAMILY CONTRACTS...181
REFRAMING ...181
PUNCTUATION ...182
UNBALANCING ...183
RESTRUCTURING...183
ENACTMENT ...183
BOUNDARY FORMATION ...183
WORKING WITH SPONTANEOUS INTERACTION ...183
INTENSITY...183
SHAPING COMPETENCE...183
ADDING COGNITIVE CONSTRUCTIONS ...183
VI/ COMMUNICATION SKILL BUILDING TECHNIQUES...184
REFLECTING ...184
REPEATING...184
FAIR FIGHTING...184
TAKING TURNS EXPRESSING FEELINGS ...184
NONJUDGMENTAL BRAINSTORMING...184
EFFECTIVE COMMUNICATION...185
Problem - Centered Systems Family Therapy...186
Stages and Steps of Therapy ...186
Assessment...186
Contracting...186
Treatment ...186
Closure ...186
A Guideline for Family Assessment ...186
1. Orientation...186
2. Data Gathering ...186
3. Problem List ...186
4. Problem Clarification ...186
Summary of Dimension Concepts ...187
Problem-solving ...187
Seven stages to the process ...187
Communication ...187
Roles...187
Other family functions: ...187
Affective Responsiveness ...187
Affective Involvement ...187
Behavior Control...187
Structure of a Family Therapy Session...188
Instructions...188
1. Research and Background...188
2. Family Session ...188
Structure of Family Therapy ...189
A. Assumptions ...190
B. Salvador Minuchin ...190
D. Normal family development...191
E. The development of behaviour disorders ...191
F. Goals of therapy...191
G. Techniques — join, map, transform structure...191
1. Joining and accommodating, then taking a position of leadership ...191
2. Enactment for understanding and change ...191
3. Working with interaction and mapping the underlying structure ...191
4. Diagnosing ...191
5. Highlighting and modifying interpersonal interactions is essential...191
6. Boundary making and boundary strengthening ...192
7. Unbalancing may be necessary ...192
8. Challenging the family’s assumptions may be necessary ...192
Systemic Family Therapy Manual...197
1. Introduction ...197
1.1 Origins of the Manual ...197
1.2 Aims and applicability of the manual ...197
1.3 Notes on use of manual ...197
1.4 Ethical & Culturally Sensitive Practice...198
1.5
Clinical Examples ...198
2. Guiding Principles...199
2.1 Systems Focus...199
2.2 Circularity ...199
2.3 Connections and Patterns ...199
2.4 Narratives and Language...199
2.5 Constructivism ...199
2.6 Social Constructionism ...199
2.7 Cultural Context ...199
2.8 Power...200
2.9 Co-constructed therapy ...200
2.10 Self-Reflexivity ...200
2.11 Strengths and Solutions...200
3. Outline of Therapeutic Change ...201
3.1 Models of Therapeutic Change ...201
3.2 Overview of Specific Goals ...202
4. Outline of Therapist Interventions ...203
4.1 Linear Questioning...203
4.2 Circular Questions...203
4.3 Statements ...204
4.4 Reflecting Teams ...204
4.5 Child Centred Interventions ...206
5. Therapeutic Setting ...207
5.1 Convening Sessions ...207
5.2 Team...207
5.3 Video ...207
5.4 Pre-therapy preparation...207
5.5 Pre & Post Session Preparation...208
5.6 Correspondence...209
5.7 Case notes...209
5.8 Session notes ...209
6. Initial sessions ...210
Goals during initial session ...210
6.1. Outline Therapy Boundaries & Structure ...210
6.2 Engage and Involve all family members...211
6.3 Gather and Clarify Information...211
6.4 Establish Goals and Objectives of Therapy ...211
Initial Session Checklist for Therapists...212
7. Middle Sessions ...213
7.1 Develop engagement...213
7.2 Gather Information & Focus Discussion...213
7.3 Identify & Explore Beliefs ...213
7.4 Work towards change at the level of beliefs and behaviours...215
7.5 Return to Objectives and Goals of Therapy...220
Middle Sessions Checklist for Therapists ...220
8. End Sessions...222
Goals during ending sessions ...222
8.1 Gather Information & Focus Discussion...222
8.2 Continue to work towards change at the level of behaviours and beliefs...222
8.3
Develop family understanding about behaviours and beliefs ...223
8.4
Collaborative ending decision...223
8.5 Review the process of therapy ...224
End Sessions Checklist for Therapists ...224
9. Indirect Work ...225
9.1 Child Protection ...225
9.2 Clarifying therapy with referrer present...225
9.3 Identifying the network and clarifying relationships ...226
9.4 Assessing risk...226
10. Proscribed Practices ...227
10.1
Advice ...227
10.2 Interpretation ...227
10.3 Un-transparent/Closed Practice...227
10.4 Therapist monologues ...227
10.5 Consistently siding with one person ...227
10.6 Working in the transference ...227
10.7 Inattention to use of language ...227
10.8 Reflections...227
10.9 Polarised position ...227
10.11
Sticking in one time frame ...228
10.12
Agreeing / not challenging ideas...228
10.13 Ignoring information that contradicts hypothesis ...228
10.14 Dismissing ideas...228
10.15 Inappropriate affect ...228
10.16 Ignoring family affect ...228
10.17 Ignoring difference...228
APPENDIXES...229
Appendix 1: Sample Appointment Letter ...229
Appendix II: Sample Video Consent Form...230
Appendix III: Sample Referrer letter ...231
Appendix IV: Post-assessment letter ...232
Appendix V: Closing letter to referrer ...233
Appendix VI : Session Notes Record Form...234
BASIC FAMILY THERAPY TECHNIQUES ...239
ACCOMMODATION ...239
ADVICE & INFORMATION...239
AFFECTIVE CONFRONTATION ...239
ASKING PERMISSION...240
BEGINNER’S MIND ...240
BOUNDARY FORMATION ...240
ADDING COGNITIVE CONSTRUCTIONS ...241
1.Advice & Information ...241
2. Pragmatic fictions...241
3. Paradox...241
COMMUNICATION TECHNIQUES...241
1. MATCHING THE CLIENT’S LANGUAGE ...241
2. MATCHING SENSORY MODALITIES...241
3. CHANNELING THE CLIENT’S LANGUAGE...241
4. USE OF VERB FORMS...241
5. GIVE CLOSE EXAMINATION TO THEIR LANGUAGE AND YOURS...241
COMMUNICATION SKILL-BUILDING TECHNIQUES...242
1. REFLECTING ...242
2. REPEATING...242
3. FAIR FIGHTING TECHNIQUES...242
CONCLUSION ...242
CONFIRMATION OF A FAMILY MEMBER: ...242
DEFRAMING ...242
DETRIANGULATION...244
DIAGNOSING...244
DIFFERENTIATION OF SELF ...244
DISEQUILIBRIUM TECHNIQUES...244
1. REFRAMING: ...244
3. BOUNDARY MAKING...246
4. PUNCTUATION: ...247
4. UNBALANCING: ...247
LESSONS IN EFFECTIVE COMMUNICATION ...248
EMOTIONAL CUT-OFF ...249
THE EMPTY CHAIR ...250
ENACTMENT ...250
FAMILY CHOREOGRAPHY...250
FAMILY CONTRACT...250
FAMILY COUNCIL MEETINGS ...250
FAMILY FLOOR PLAN...251
FAMILY LIFE CYCLE...251
FAMILY PHOTOS...251
FAMILY SCULPTING ...251
FAMILY SYSTEM STRATEGIES...252
THE GENOGRAM...252
GOAL SETTING ...252
ICEBREAKER COMPLIMENT OR POSITIVE STATEMENT ...252
IDENTIFICATION...253
INFORMATION-GATHERING TECHNIQUES ...253
2. Family Photos...253
3. Family Floorplan...253
INTENSITY...253
INTERVENTION TECHNIQUES ...253
INVOLUNTARY CLIENT SHEMA ...253
JOINING ...255
1. Tracking: ...255
2. Mimesis:...255
3. Confirmation of a family member: ...255
4. Accommodation: ...255
5. Maintenance ...256
NORMALIZATION ...256
OBSERVATION...258
POSITIVE CONNOTATION...258
PARADOXICAL INJUNCTIONS ...259
PRAGMATIC FICTIONS ...259
PRESCRIBING INDECISION...259
PROBLEM TRACKING ...260
PROBLEM SOLVING TECHNIQUES ...260
PROBLEM DISSOLUTION ...260
PUNCTUATION ...260
PUTTING CLIENT IN CONTROL OF THE SYMPTOM...260
QUESTIONS...261
1. THE MIRACLE QUESTION:...261
2. FAST-FORWARDING QUESTIONS ...261
3. THE EXCEPTION QUESTION:...261
4. STRATEGIC BASIC QUESTIONS:...261
5. PROVOCATIVE QUESTIONS: ...261
6. SCALING QUESTIONS AND PERCENTAGE QUESTIONS ...261
7. EXCEPTION SEEKING QUESTIONS ...262
8. COPING QUESTIONS...262
9. OPEN QUESTIONS ...263
10. PROCESS QUESTIONS. ...264
11. LINEAR QUESTIONS...264
12. CIRCULAR QUESTIONS ...264
15. PROBLEM TRACKING QUESTIONS ...268
16. CONVERSATIONAL QUESTIONS ...270
17. FRAMING QUESTIONS ...272
18. DEFRAMING QUESTIONS...272
REFRAMING ...272
REFRAMING PROBLEM DEFINITIONS ...272
RESTRUCTURING...273
SHAPING COMPETENCE...273
USE OF SILENCE...273
SPECIAL DAYS, MINI-VACATIONS, SPECIAL OUTINGS ...274
WORKING WITH SPONTANEOUS INTERACTION ...274
STRATEGIC ALLIANCES...274
TRACKING ...274
UNBALANCING ...275
INTRODUCING UNCERTAINTY...275
Summary of Family Therapy Theories & Techniques ...282
Family Therapy Survey ...282
I. The Foundations of Family Therapy - Outline by David Peers...282
A. The myth of the hero ...282
B. Psychotherapeutic sanctuary ...282
C. Family vs. Individual therapy...282
D. Psychology and social context ...282
E. The power of family therapy ...283
F. Contemporary cultural influences...283
G. Thinking in lines vs. Thinking in circles...283
II. The Evolution Of Family Therapy - Outline by Lori Rice...284
A. The undeclared war ...284
B. Small group dynamics ...284
C. Child guidance movement...284
D. The influence of social work...284
E. Research on family dynamics and the etiology of schizophrenia...284
III. Early Models And Basic Techniques - Outline by Sarah Sifers: ...285
A. Family therapy has a history of being condescending ...285
B. Sketches of leading figures...285
C. Theoretical formulations - group...285
D. Theoretical formulations - communications ...285
E. Normal family development ...286
F. Development of behavior disorders ...286
G. Goals of therapy ...286
H. Conditions for behavior change ...286
I. Techniques of group family therapy...286
J. Techniques of communications family therapy...286
K. Lessons from early models...287
L. System’s anxiety...287
M. Stages of family therapy ...287
N. Family assessment...287
O. Working with managed care - it’s necessary, so cooperate ...287
IV. The Fundamental Concepts Of Family Therapy - Outline by Anabella Pavon...288
A. Conceptual influences on the evolution of family therapy ...288
B. Enduring concepts and methods...289
V. Bowen Family Systems Therapy - Outline by Jared Warren...290
A. Sketches of leading figures ...290
B. Theoretical formulations ...290
C. Normal family development...290
D. Development of behaviour disorders ...291
E. Goals of therapy...291
F. Conditions for behavior change ...291
G. Techniques ...291
H. Evaluating therapy theory and results ...291
I. Summary - Seven prominent techniques ...291
VI. Experiential Family Therapy Outline by Sarah Sifers ...292
A. Leading figures and background ...292
B. Theoretical formulations ...292
C. Normal family development...292
D. Development of behavior disorders ...292
E. Goals of therapy...293
F. Conditions for behavior change ...293
G. techniques...293
H. Evaluation...293
VII. Psychoanalytic Family Therapy Outline by Anabella Pavon ...294
A. Introduction ...294
B. Sketches of leading figures...294
C. Theoretical formulations ...294
D. Normal family development...294
E. Development of behavior disorders...295
F. Goals of therapy...295
G. Conditions for behavior change ...295
H. Techniques ...295
VIII. Structure Family Therapy — Outline by Patty Salehpur ...296
A. Assumptions ...296
B. Salvador Minuchin ...296
C. Theoretical formulations - three essential constructs ...296
D. Normal family development...296
E. The development of behavior disorders ...296
F. Goals of therapy...297
G. Techniques — join, map, transform structure...297
Family Therapy – Background Information
From Wikipedia, the Free Encyclopedia
Family therapy, also referred to as couple and family therapy and family systems therapy, is a branch of psychotherapy that works with families and couples in intimate relationships to nurture change and development. It tends to view change in terms of the systems of interaction between family members. It emphasizes family relationships as an important factor in psychological health.
What the different schools of family therapy have in common is a belief that, regardless of the origin of the problem, and regardless of whether the clients consider it an "individual" or "family" issue, involving families in solutions is often beneficial. This involvement of families is commonly accomplished by their direct
participation in the therapy session. The skills of the family therapist thus include the ability to influence conversations in a way that catalyzes the strengths, wisdom, and support of the wider system.
In the field's early years, many clinicians defined the family in a narrow, traditional manner usually including parents and children. As the field has evolved, the concept of the family is more commonly defined in terms of strongly supportive, long-term roles and relationships between people who may or may not be related by blood or marriage.
Family therapy has been used effectively in the full range of human dilemmas; there is no category of relationship or psychological problem that has not been addressed with this approach. The conceptual
frameworks developed by family therapists, especially those of family systems theorists, have been applied to a wide range of human behaviour, including organizational dynamics and the study of greatness.
Contents
1 History and theoretical frameworks
2 Techniques
3 Publications
4 Licensing and degrees
o 4.1 Values and ethics in family therapy
5 Founders and key influences
6 Summary of Family Therapy Theories & Techniques
7 Academic resources
8 Professional Organizations
9 See also
10 References
History of Marital Therapy
Guman &Fränkel point out that couples therapy (formerly marital therapy) has been largely neglected, even though family therapists do 1.5-2 times as much couple work as multigenerational family work. They also note this is not such a bad ratio, as 40% of people coming to therapy attribute their problems to relationship issues. (Gurman, A. S. & Fraenkel, P. (2002). The history of couple therapy: A millennial review. Family Process, 41, 199-260.)
G&F define Four Phases in the History of Couples Therapy: Phase I - 1930 to 1963 - Atheoretical
1929 to 1932 - Three marital clinics opened; they were service and education oriented, and saw mostly individuals
The closest thing to theory was what was borrowed from psychoanalytic - interlocking neurosis
1931 the first marital therapy paper was published
Theory was marginalized due to a lack of brilliant theorists, and a lack of distinction from individual analysis
Phase II - 1931 to 1966 - Psychoanalytic Experimentation
Therapists are seen as telling truth from distortion, rather than creating a truth
Mostly individual sessions, but some conjoint; still treated like seeing two individual clients in the same room though
Some started to downplay the role of the therapist
Family was outshining couples work, and the couple techniques weren't innovative or particularly effective
Phase III - 1963 to 1985 - Family Therapy Incorporates
Family therapy overpowers couples, even though a number of big name people really mostly saw couples
o Jackson
Coined concepts like quid pro quo, homeostasis, and double bind for conjoint therapy
o Satir
Coined naming roles members played, fostered self-esteem and actualization, and saw the therapist as a nurturing teacher
o Bowen
Multigenerational theory approach, with differentiation, triangulation, and projection processes, with the therapist as an anxiety-lowering coach - societal projection process was the forerunner of our modern awareness of cultural differences.
o Haley
Power and control (or love and connection) were key. Avoided insight, emotional catharsis, conscious power plays. Saw system as more, and more important, than the sum of the parts Phase IV - 1986 to now - Refining and Integrating
1986 was the publication of G&K book
New Theories were tried and refined, like Behavioural Marital Therapy, Emotionally Focused Marital Therapy, and Insight-Oriented Marital Therapy. All four have received good empirical support. Couples therapy was used to treat depression, anxiety, and alcoholism.
Efforts were focused on preventing couples problems with programs like PREP
Feminism, Multiculturalism, and Post-Modernism impacted the field
Eclectic integration, brief therapy, and sex therapy ideas were incorporated into our work.
History and theoretical frameworks
Formal interventions with families to help individuals and families experiencing various kinds of problems have been a part of many cultures, probably throughout history. These interventions have sometimes involved formal procedures or rituals, and often included the extended family as well as non-kin members of the community (see for example Ho'oponopono). Following the emergence of specialization in various societies, these interventions were often conducted by particular members of a community – for example, a chief, priest, physician, and so on - usually as an ancillary function.
Family therapy as a distinct professional practice within Western cultures can be argued to have had its origins in the social work movements of the 19th century in England and the United States. As a branch of
psychotherapy, its roots can be traced somewhat later to the early 20th century with the emergence of the child guidance movement and marriage counselling.The formal development of family therapy dates to the 1940s and early 1950s with the founding in 1942 of the American Association of Marriage Counsellors (the precursor of the AAMFT), and through the work of various independent clinicians and groups - in England (John Bowlby at the Tavistock Clinic), the US (John Bell, Nathan Ackerman, Christian Midelfort, Theodore Lidz, Lyman Wynne, Murray Bowen, Carl Whitaker, Virginia Satir), and Hungary (D.L.P. Liebermann) - who began seeing family members together for observation or therapy sessions. There was initially a strong influence from psychoanalysis (most of the early founders of the field had psychoanalytic backgrounds) and social psychiatry, and later from learning theory and behaviour therapy - and significantly, these clinicians began to articulate various theories about the nature and functioning of the family as an entity that was more than a mere aggregation of individuals.
The movement received an important boost in the mid-1950s through the work of anthropologist Gregory Bateson and colleagues – Jay Haley, Donald D. Jackson, John Weakland, William Fry, and later, Virginia Satir, Paul Watzlawick and others – at Palo Alto in the US, who introduced ideas from cybernetics and general systems theory into social psychology and psychotherapy, focusing in particular on the role of communication (see Bateson Project). This approach eschewed the traditional focus on individual psychology and historical factors – that involve so-called linear causation and content – and emphasized instead feedback and homeostatic mechanisms and “rules” in here-and-now interactions – so-called circular causation and process – that were thought to maintain or exacerbate problems, whatever the original cause(s). (See also systems psychology and systemic therapy.) This group was also influenced significantly by the work of US psychiatrist, hypnotherapist, and brief therapist, Milton H. Erickson - especially his innovative use of strategies for change, such as
paradoxical directives (see also Reverse psychology). The members of the Bateson Project (like the founders of a number of other schools of family therapy, including Carl Whitaker, Murray Bowen, and Ivan Böszörményi-Nagy) had a particular interest in the possible psychosocial causes and treatment of schizophrenia, especially in terms of the putative "meaning" and "function" of signs and symptoms within the family system. The research of psychiatrists and psychoanalysts Lyman Wynne and Theodore Lidz on communication deviance and roles (e.g., pseudo-mutuality, pseudo-hostility, schism and skew) in families of schizophrenics also became influential with systems-communications-oriented theorists and therapists.A related theme, applying to
dysfunction and psychopathology more generally, was that of the "identified patient" or "presenting problem" as a manifestation of or surrogate for the family's, or even society's, problems. (See also double bind; family nexus.)
By the mid-1960s a number of distinct schools of family therapy had emerged. From those groups that were most strongly influenced by cybernetics and systems theory, there came MRI Brief Therapy, and slightly later, strategic therapy, Salvador Minuchin's Structural Family Therapy and the Milan systems model. Partly in reaction to some aspects of these systemic models, came the experiential approaches of Virginia Satir and Carl Whitaker, which downplayed theoretical constructs, and emphasized subjective experience and unexpressed feelings (including the subconscious), authentic communication, spontaneity, creativity, total therapist
engagement, and often included the extended family. Concurrently and somewhat independently, there emerged the various intergenerational therapies of Murray Bowen, Ivan Böszörményi-Nagy, James Framo, and Norman Paul, which present different theories about the intergenerational transmission of health and dysfunction, but which all deal usually with at least three generations of a family (in person or conceptually), either directly in therapy sessions, or via "homework", "journeys home", etc. Psychodynamic family therapy - which, more than any other school of family therapy, deals directly with individual psychology and the unconscious in the context of current relationships - continued to develop through a number of groups that were influenced by the ideas and methods of Nathan Ackerman, and also by the British School of Object Relations and John Bowlby’s work on attachment. Multiple-family group therapy, a precursor of psycho educational family intervention, emerged, in
part, as a pragmatic alternative form of intervention - especially as an adjunct to the treatment of serious mental disorders with a significant biological basis, such as schizophrenia - and represented something of a conceptual challenge to some of the "systemic" (and thus potentially "family-blaming") paradigms of pathogenesis that were implicit in many of the dominant models of family therapy. The late-1960s and early-1970s saw the development of network therapy (which bears some resemblance to traditional practices such as Ho'oponopono) by Ross Speck and Carolyn Attneave, and the emergence of behavioural marital therapy (renamed behavioural couples therapy in the 1990s; see also relationship counselling) and behavioural family therapy as models in their own right.
By the late-1970s the weight of clinical experience - especially in relation to the treatment of serious mental disorders - had led to some revision of a number of the original models and a moderation of some of the earlier stridency and theoretical purism. There were the beginnings of a general softening of the strict demarcations between schools, with moves toward rapprochement, integration, and eclecticism – although there was, nevertheless, some hardening of positions within some schools. These trends were reflected in and influenced by lively debates within the field and critiques from various sources, including feminism and post-modernism, that reflected in part the cultural and political tenor of the times, and which foreshadowed the emergence (in the 1980s and 1990s) of the various "post-systems" constructivist and social constructionist approaches. While there was still debate within the field about whether, or to what degree, the systemic-constructivist and medical-biological paradigms were necessarily antithetical to each other (see also Anti-psychiatry; Bio psychosocial model), there was a growing willingness and tendency on the part of family therapists to work in multi-modal clinical partnerships with other members of the helping and medical professions.
From the mid-1980s to the present the field has been marked by a diversity of approaches that partly reflect the original schools, but which also draw on other theories and methods from individual psychotherapy and elsewhere – these approaches and sources include: brief therapy, structural therapy, constructivist approaches (e.g., Milan systems, post-Milan/collaborative/conversational, reflective), solution-focused therapy, narrative therapy, a range of cognitive and behavioural approaches, psychodynamic and object relations approaches, attachment and Emotionally Focused Therapy, intergenerational approaches, network therapy, and multi systemic therapy (MST). Multicultural, intercultural, and integrative approaches are being developed. Many practitioners claim to be "eclectic," using techniques from several areas, depending upon their own inclinations and/or the needs of the client(s), and there is a growing movement toward a single “generic” family therapy that seeks to incorporate the best of the accumulated knowledge in the field and which can be adapted to many different contexts; however, there are still a significant number of therapists who adhere more or less strictly to a particular, or limited number of, approach(es).
Ideas and methods from family therapy have been influential in psychotherapy generally: a survey of over 2,500 US therapists in 2006 revealed that of the ten most influential therapists of the previous quarter-century, three were prominent family therapists, and the marital and family systems model was the second most utilized model after cognitive behavioural therapy.
As we move through the 21st century, the internet is fostering the growth of online programs that make courses and programs in family therapy more widely accessible. Using mass media techniques to increase public understanding of issues in family therapy has added a new frontier for amplification in the future.
Techniques
Family therapy uses a range of counselling and other techniques including:
communication theory
media and communications psychology
psychoeducation psychotherapy relationship education systemic coaching systems theory reality therapy
The number of sessions depends on the situation, but the average is 5-20 sessions.
A family therapist usually meets several members of the family at the same time. This has the advantage of making differences between the ways family members perceive mutual relations as well as interaction patterns in the session apparent both for the therapist and the family.
These patterns frequently mirror habitual interaction patterns at home, even though the therapist is now incorporated into the family system.
Therapy interventions usually focus on relationship patterns rather than on analyzing impulses of the
unconscious mind or early childhood trauma of individuals as a Freudian therapist would do - although some schools of family therapy, for example psychodynamic and intergenerational, do consider such individual and historical factors (thus embracing both linear and circular causation) and they may use instruments such as the genogram to help to elucidate the patterns of relationship across generations.
The distinctive feature of family therapy is its perspective and analytical framework rather than the number of people present at a therapy session. Specifically, family therapists are relational therapists: They are
generally more interested in what goes on between individuals rather than within one or more individuals, although some family therapists—in particular those who identify as psychodynamic, object
relations, intergenerational, EFT, or experiential family therapists—tend to be as interested in individuals as in the systems those individuals and their relationships constitute.
Depending on the conflicts at issue and the progress of therapy to date, a therapist may focus on analyzing specific previous instances of conflict, as by reviewing a past incident and suggesting alternative ways family members might have responded to one another during it, or instead proceed directly to addressing the sources of conflict at a more abstract level, as by pointing out patterns of interaction that the family might have not noticed.
Family therapists tend to be more interested in the maintenance and/or solving of problems rather than in trying to identify a single cause. Some families may perceive cause-effect analyses as attempts to allocate
blame to one or more individuals, with the effect that for many families a focus on causation is of little or no clinical utility.
Publications
Family therapy journals include: Journal of Marital and Family Therapy, Family Process, Journal of Family Therapy, Journal of Systemic Therapies, The Australian & New Zealand Journal of Family Therapy, The Psychotherapy Networker, The Journal of Sex and Marital Therapy, The Australian Journal of Family Therapy, The International Journal of Narrative Therapy and Community Work, Journal for the Study of Human
Interaction and Family Therapy,
Licensing and degrees
Family therapy practitioners come from a range of professional backgrounds, and some are specifically qualified or licensed/registered in family therapy (licensing is not required in some jurisdictions and requirements vary from place to place). In the United Kingdom, family therapists are usually psychologists, nurses, psychotherapists, social workers, or counsellors who have done further training in family therapy, either a diploma or an M.Sc.. However, in the United States there is a specific degree and license as a Marriage and Family therapist.
Prior to 1999 in California, counsellors who specialized in this area were called Marriage, Family and Child Counsellors. Today, they are known as Marriage and Family Therapists (MFT), and work variously in private practice, in clinical settings such as hospitals, institutions, or counselling organizations.
A master's degree is required to work as an MFT in some American states. Most commonly, MFTs will first earn a M.S. or M.A. degree in marriage and family therapy, psychology, family studies, or social work. After graduation, prospective MFTs work as interns under the supervision of a licensed professional and are referred to as an MFTi.
Marriage and family therapists in the United States and Canada often seek degrees from accredited Masters or Doctoral programs recognized by the Commission on Accreditation for Marriage and Family Therapy
Education(COAMFTE), a division of the American Association of Marriage and Family Therapy.
Requirements vary, but in most states about 3000 hours of supervised work as an intern are needed to sit for a licensing exam. MFTs must be licensed by the state to practice. Only after completing their education and internship and passing the state licensing exam can a person call themselves a Marital and Family Therapist and work unsupervised.
License restrictions can vary considerably from state to state. Contact information about licensing boards in the United States are provided by the Association of Marital and Family Regulatory Boards.
There have been concerns raised within the profession about the fact that specialist training in couples therapy – as distinct from family therapy in general - is not required to gain a license as an MFT or membership of the main professional body, the AAMFT.
Values and ethics in family therapy
Since issues of interpersonal conflict, power, control, values, and ethics are often more pronounced in
relationship therapy than in individual therapy, there has been debate within the profession about the different values that are implicit in the various theoretical models of therapy and the role of the therapist’s own values in the therapeutic process, and how prospective clients should best go about finding a therapist whose values and objectives are most consistent with their own. Specific issues that have emerged have included an increasing questioning of the longstanding notion of therapeutic neutrality, a concern with questions of justice and self-determination,connectedness and independence, "functioning" versus "authenticity", and questions about the degree of the therapist’s "pro-marriage/family" versus "pro-individual" commitment.
Founders and key influences
Some key developers of family therapy are:
Alfred Adler (phenomenology)
Nathan Ackerman (psychoanalytic)
Tom Andersen (Reflecting practices and dialogues about dialogues)
Harlene Anderson (Postmodern Collaborative Therapy and Collaborative Language Systems)
Harry J Aponte (Person-of-the-Therapist)
Gregory Bateson (1904–1980) (cybernetics, systems theory)
Ivan Böszörményi-Nagy (Contextual therapy, intergenerational, relational ethics)
Murray Bowen (Systems theory, intergenerational)
Steve de Shazer (solution focused therapy)
James Dobson (Christian psychologist) Focus on the Family
Milton H. Erickson (hypnotherapy, strategic therapy, brief therapy)
Richard Fisch (brief therapy, strategic therapy)
James Framo (object relations theory, intergenerational)
Edwin Friedman (Family process in religious congregations)
Harry Goolishian (Postmodern Collaborative Therapy and Collaborative Language Systems)
John Gottman (marriage)
Robert-Jay Green (LGBT, cross-cultural issues)
Jay Haley (strategic therapy, communications)
Lynn Hoffman (strategic, post-systems, collaborative)
Don D. Jackson (systems theory)
Sue Johnson (Emotionally focused therapy, attachment theory)
Bradford Keeney (cybernetics, resource focused therapy)
Walter Kempler (Gestalt psychology)
Bernard Luskin (media psychology, Public understanding of issues through media)
Cloe Madanes (strategic therapy)
Salvador Minuchin (structural)
Braulio Montalvo (structural)[citation needed]
Virginia Satir (communications, experiential, conjoint and co-therapy)
Mara Selvini Palazzoli (Milan systems)
Ross Speck (network therapy)
Robin Skynner (Group Analysis)
Paul Watzlawick (Brief therapy, systems theory)
John Weakland (Brief therapy, strategic therapy, systems theory)
Carl Whitaker (Family systems, experiential, co-therapy)
Michael White (narrative therapy)
Lyman Wynne (Schizophrenia, pseudomutuality)
Principal Leaders in the Field:
Salvador Minuchin Jay Haley Murray Bowen Nathan Ackerman Virginia Satir Ivan Boszmormenyi-Nagy John Elderkin Bell
Philip Guerin
Don Jackson
Carl Whitaker
Betty Carter
Salvador Minuchin
Born and raised in Argentina, Salvador Minuchin began his career as a family therapist in the early 1960's when he discovered two patterns common to troubled families: some are "enmeshed," chaotic and
tightly interconnected, while others are "disengaged," isolated and seemingly unrelated. When
Minuchin first burst onto the scene, his immediate impact was due to his dazzling clinical artistry. This compelling man with the elegant Latin accent would provoke, seduce, bully, or bewilder families into changing -- as the situation required -- setting a standard against which other therapists still judge their best work. But even Minuchin's legendary dramatic flair didn't have the same galvanizing impact as his
structural theory of families.
In his classic text, Families and Family Therapy (Minuchin, 1974) Minuchin taught family therapists to see what they were looking at. Through the lens of structural family theory, previously puzzling interactions suddenly swam into focus. Where others saw only chaos and cruelty, Minuchin helped us understand that
families are structured in "subsystems" with "boundaries," their members shadowing to steps they do not see.
In 1962 Minuchin formed a productive professional relationship with Jay Haley, who was then in Palo Alto. In 1965 Minuchin became the director of the Philadelphia Child Guidance Clinic, which eventually became the world's leading center for family therapy and training. At the Philadelphia Clinic, Haley and Minuchin developed a training program for members of the local black community as paraprofessional family therapists in an effort to more effectively related to the urban blacks and Latinos in the surrounding community.
In 1969, Minuchin, Haley, Braulio Montalvo, and Bernice Rosman developed a highly successful family therapy training program that emphasized hands-on experience, on-line supervision, and the use of videotapes to learn and apply the techniques of structural family therapy. Minuchin stepped down as director of the Phildelphia Clinic in 1975 to pursue his interest in treating families with psychosomatic illnesses and to continue writing some of the most influential books in the field of family therapy. In 1981, Minuchin established Family Studies, Inc., in New York, a center committed to teaching family therapists. Minuchin retired in 1996 and currently lives with his wife Patricia in Boston.
Jay Haley
A brilliant strategist and devastating critic, Jay Haley was a dominating figure in developing the Palo Alto Group's communications model and strategic family therapy, which became popular in the 1970's. He studied under three of the most influential pioneers in the evolution of family therapy - Gregory Bateson, Milton Erickson, and Salvador Minuchin, and combined ideas from each of these innovative thinkers to form his own unique brand of family therapy.
In 1953 Haley was studying for a master's degree in communication at Stanford University when Gregory Bateson invited him to work on the schizophrenia project. Haley met with patients and their families to observe the communicative style of schizophrenics in a natural environment. This work had an enormous impact in shaping the development of family therapy.
Haley developed his therapeutic skills under the supervision of master hypnotist Milton Erickson from 1954 to 1960. Haley developed a brief therapy model which focused on the context and possible function of the patient's symptoms and used directives to instruct patients to act in ways that were counterproductive to their maladaptive behavior. Haley believed that it was far more important to get patients to actively do something about their problems rather than help them to understand why they had these problems.
Haley was instrumental in bridging the gap between strategic and structural approaches to family therapy by looking beyond simple dyadic relationships and exploring his interest in triangular, inter generational
relationships, or "perverse triangles." Haley believed that a patient's symptoms arose out of an incongruence between manifest and covert levels of communication with others and served to give the patient a sense of control in their interpersonal relationships. Accordingly, Haley thought that the
healing aspect of the patient-therapist relationship involved getting patients to take responsibility for their actions and to take a stand in the therapeutic relationship, a process he called "therapeutic paradox."
Haley conducted research at the Mental Research Institute in Palo Alto until he joined Salvador Minuchin at the Philadelphia Child Guidance Clinic in 1967. At the Philadelphia Clinic, Haley pursued his interests in training and supervision in family therapy and was the director of family therapy research for ten years. He
was also an active clinical member of the University of Pennsylvania's Department of Psychiatry. In 1976, Haley moved to Washington D.C. and founded the Family Therapy Institute with Cloe Madanes, which has become one of the major training institutes in the country. Haley retired in 1995 and currently lives in La Jolla, California.
Murray Bowen
Among the pioneers of family therapy, Murray Bowen's emphasis on theory and insight as opposed to action and technique distinguish his work from the more behaviorally oriented family therapists (Nichols & Schwartz, 1998. Family Therapy: Concepts and Methods. 4th ed. Allyn & Bacon). Bowen's therapy is an outgrowth of psychoanalytic theory and offers the most comprehensive view of human behavior and problems of any approach to family therapy. The core goal underlying the Bowenian model is
differentiation of self, namely, the ability to remain oneself in the face of group influences, especially
the intense influence of family life. The Bowenian model also considers the thoughts and feelings of each family member as well as the larger contextual network of family relationships that shapes the lie of the family.
Bowen grew up in Waverly, Tennessee, the oldest child of a large cohesive family. After graduating from medical school and serving five years in the military, Bowen pursued a career in psychiatry. He began studying schizophrenia and his strong background in psychoanalytic training led him to expand his studies from individual patients to the relationship patterns between mother and child. From 1946 to 1954, Bowen studied the symbiotic relationships of mothers and their schizophrenic children at the Menninger Clinic in Topeka, Kansas. Here he developed the concepts of anxious and functional attachment to describe
interactional patterns in the mother-child relationship.
In 1954, Bowen became the first director of the Family Division at the National Institute of Mental Health (NIMH). He further broadened his attachment research to include fathers and developed the concept of
triangulation as the central building block o relationship systems (Nichols & Schwartz, 1998. Family
Therapy: Concepts and Methods. 4th ed. Allyn & Bacon). In his first year at NIMH, Bowen provided separate therapists for each individual member of a family, but soon discovered that this approach
fractionated families instead of bringing them together. As a result, Bowen decided to treat the entire family as a unit, and became one of the founders of family therapy.
In 1959, Bowen began a thirty-one year career at Georgetown University's Department of Psychiatry where he refined his model of family therapy and trained numerous students, including Phil Guerin, Michael Kerr, Betty Carter, and Monica McGoldrick, and gained international recognition for his leadership in the field of family therapy. He died in October 1990 following a lengthy illness.
Nathan Ackerman
Nathan Ackerman's astute ability to understand the overall organization of families enabled him to look beyond the behavioral interactions of families and into the hearts and minds of each family member. He used his strong will and provocative style of intervening to uncover the family's defenses and allow their
feelings, hopes, and desires to surface. Ackerman's training in the psychoanalytic model is evident in his
contributions and theoretical approach to family therapy. Ackerman proposed that underneath the
apparent unity of families there existed a wealth of intra psychic conflict that divided family members into factions (Nichols & Schwartz, Family Therapy: Concepts and Methods. 4th ed. Allyn &
Bacon 1998). Ackerman joined the Menninger Clinic in Topeka, Kansas, and became the chief psychiatrist of the Child Guidance Clinic in 1937.
Initially, Ackerman followed the child guidance clinic model of having a psychiatrist treat the child and a social worker see the mother (Nichols & Schwartz, Family Therapy: Concepts and Methods. 4th ed. Allyn & Bacon 1998). However, within his first year of work at the clinic, Ackerman became a strong advocate of including the entire family when treating a disturbance in one of its members, and suggested that family therapy be used as the primary form of treatment in child guidance clinics (Nichols & Schwartz, 1998. Family Therapy: Concepts and Methods. 4th ed. Allyn & Bacon).
Ackerman was committed to sharing his ideas and theoretical approach with other professionals in the field. In 1938 Ackerman published The Unity of the Family and Family Diagnosis: An Approach to the Preschool Child, both of which inspired the family therapy movement. Together with Don Jackson, Ackerman
