Kuliah Model Terapi Keluarga

Lima Model Terapi Keluarga

_{Terapi Keluarga Bowen} _{Terapi Keluarga Struktur} _{Terapi keluarga Strategik}

_{Terapi keluarga Experiential/ Komunikasi}



Masyarakat Malaysia tradisional

Pengenalan



_{Working with family members, all or part, to}

bring about change in the family organization.



_{It is complex and multifaceted - there is no}

simple correct approach



_{Makes a shift from an individual to systemic}

Basic Principles



_{Focus is on interaction and communication}

An individual influences his context and is

influenced by it



_{Changes in organization/structure contribute}

to changes in behavior



_{http://www.goldentriadfilms.com/films/tapes.ht}

Roots



_{Psychoanalytic Approach (Freud) and}

Client-Centered Therapy (Rogers) – both treated

client in private to maintain purity of

FAMILY VS. INDIVIDUAL

THERAPY:



_{Both offer an approach to treatment and a way}

of understanding human behavior



_{Individual therapy focuses on internalized}

influences of family and intrapsychic dynamics



_{Family therapy believes the dominate forces in}



Therapy focuses on changing the family

organization



_{When family organization is transformed, the}

lives of every family member are altered

accordingly



_{Family therapy exerts change on the entire}

family (not just individual in context) –

improvements can be lasting because each

member is changed and continues to exert

change on each other

FAMILY THERAPY PROCESS

 _{Family Assessment:}

 _{Some very formal – with structured questions and genograms;}

others conduct little formal evaluation

 _{Presenting Problem:}

 _{What is family saying, what have they tried to do to solve}

problem

 _{Understanding Referral Source:}  _{Expectations, agendas, etc}

 _{Identifying Systemic Context:}  _{Who makes-up the family}

 _{Stage of Life Cycle:}

Samb.

 _{Family Structure:}

 _{Who plays what roles in the family}

 _{Communication:}

 _{Process and content}

 _{Divorce, Domestic Violence, Sexual Abuse, Affairs}

 _{Explore safety issues, secondary issues}

 _{Gender, Cultural Factors, Ethics: Managed}

Care:

Family Therapy Pie

Bowen-Intergenerational Theory.

 _{Intergenerational Family Therapy atau}

Bowen-Intergenerational Theory.

 _{Murray Bowen – 1950an, Kehidupan keluarganya}

beri impak besar dalam teorinya.

 _{Ahli terapis yang pertama menggunakan teori sistem}

dalam terapi keluarga.

 _{Bowen percaya sistem emosi wujud dalam keluarga}

dan mempengaruhi generasi seterusnya dengan pola berulangan.

 _{Corak emosi – emotionally overinvolved (fusion) atau}

emotionally cut off pengelakkan fisikal atau

Bowen-Intergenerational Theory.



Elemen penting teori- “that here is a chronic

anxiety in all of life that comes with the

territory of living”. Freidman, 1991, p.139.



_{Keluarga bermasalah – anxiety tinggi (kronik)}

 stress, sakit fizikal / psikologi (boleh

dijangkakan)

Bowen-Intergenerational Theory

 _{8 konsep asas:}

 _{1. Perbezaan Kendiri (Differentiation of Self)}

 - keupayaan seseorang membezakan dirinya dari

keluarga asalnya pada tahap emosi dan intelektual. Kehidupan – “togetherness dan individuality”

 Negatif: Fused atau “undifferentiated family ego mass”.  Matlamat : Seimbang emosi dan kognitif.

 Contoh: Pelajar kolej yang pulang untuk meraikan

perkahwinan kakaknya dan masa yang sama keluarga mengalami konflik. Apakah darjah perbezaan

Bowen-Intergenerational Theory

 _{Darjah Differention of Self :}

 1. below 50 (Low differentiation)

 _{- tries to please others, seek others, bergantungan,}

avoids conflict, lacks of capacity of autonomy.

 _{2. 51-75 ( Midrange differentiation)}

 _{- has definite beliefs and values but tends to}

overconcerned with the opinions of others.

 _{3. 76-100 ( high differentiation)}

 _{Jelas nilai dan kepercayaan, goal directed, flexible,}

secure, autonomous, can tolerate conflicts and stress, well defined sense of solid self and less pseudo self/ pretend self( Roberto, 1992)

Bowen-Intergenerational Theory

 _{2. Segi Tiga (Triangles)  interlocking triangles}

 _{3. Sistem emosi keluarga asas ( Nuclear family emotional system)}  _{4. Proses projeksi keluarga (Family projection process)}

 _{5. Emotional cut-off – pengelakan untuk tidak berhubung, keluarga}

yang anxieti

 _{6. Proses transmisi pelbagai generasi ( multigenerational transmission}

process)

 _{7. Kedudukan adik-beradik ( sibling position- roles and function) e.g.}

pasangan berkahwin adalah anak bongsu dalam keluarga  terlalu terbeban dengan tanggungjawab dan membuat keputusan

 _{Anak sulong- bersaing}

 _{8. Societal Regression- tahap ‘differentiation’ masyarakat rendah }

lemah keputusan yang manasabah dan lebih kepada perasaan or Band Aid solutions

Bowen-Intergenerational Theory.



_Teknik:



Genogram



Going home again

_{Detriangulation}



_{Person-to person Relationships}

_{Differentiation of Self}



_{Asking Questions}

Bowen-Intergenerational Theory.



_{Aspek Unik:}



1. Sejarah keluarga – elak pengulangan

corak interaksi. Cont: Genogram



_{3. Jelas konsep dan intertwined.}

2. Sistemik, berfokus dan amalan

Terapi Keluarga Struktur

 _{Founder: Salvador Minuchin 1974}

 _{Latar belakang sebagai Child Psychiatry}

 _{Keluarga yang bermasalah ialah tiada struktur}

organisasi dan tidak fleksibel dalam menghadapi kitaran perkembangan keluarga.

 _{Struktur keluarga yg baik- organisasi kemas dengan}

mempunyai hierarki dan ahli mudah berhubungan. Mudah dan cepat berfungsi kembali setelah

menghadapi tekanan, tekar, dan ‘chaos’. keseluruhan “wholeness”

Terapi Keluarga Struktur



_{Tesis penting:}



Simptom seseorang di fahami dengan

mengkaji corak interaksi dalam konteks

keluarga.



_{Perubahan dalam organisasi atau struktur}

perlu diubah dahulu sebelum simptom

diubah.



_{Struktur keluarga mempunyai impak terhadap}

Terapi keluarga Struktur

 _{Pendekatan yang melihat keluarga sebagai satu}

organisma yang mengalami perubahan.

 _{Masalah keluarga berpusat kepada enmeshment}

and disengagement, dengan keengganan untuk berubah

 _{Peranan terapi adalah aktif, intervensi terapi ialah}

mencabar kewujudan "family reality." Strategi membantu berfokus kepada “joining” dengan keluarga dan restructure system

 _{Konsep asas:}

 _{1. Struktur keluarga: Setiap keluarga mempunyai struktur dan}

dapat dilihat apabila dilaksanakan.

 _{“Structure is an invisible set of functional demands by which}

family members relate to each other( Minuchin, 1974).

 _{- sebagai jumlah peraturan operasional yang berulang dan}

konsisten.contoh: ayah mempunyai autoriti.

 _{- bersifat tidak statik, komplementari (teamwork)}

 _{- ada struktur, hierarki, perbezaan di antara subsistem,}

Terapi Keluarga Struktur

Terapi Keluarga Struktur



_{2. Subsistem Keluarga}



Ciri- gender, generasi, minat, tugas



Subsistem pasangan, ibubapa, adik beradik,

_{- definisi: interpersonal boundaries dan}

peraturan untuk ahli. Tentukan siapa dan

apa peranan dalam subsistem.



_{wujud kerana melaksanakan family task}

-.

 _{3.Boundary Permeability}

 _{Boundaries – how a family is organized. sempadan dalam}

keluarga fleksibel ( permeability) dapat menentukan hubungan bersama ahli keluarga.

 _{Sempadan yang jelas (“saya”, “kami”, berada di tengah antara}

enmeshment dan disengagement)

 _{Sempadan yang tegar (diengagement)- kurang loyal, kurang}

berhubung, tidak melindungi keluarga, kurang “caring”

 _{Sempadan yang diffuse/berselerak ( enmeshement) – terlalu}

terlibat dan ambil tahu, eg. Children may act as parents, parental control tak berkesan, excessive togetherness

Terapi Keluarga Struktur

Terapi Keluarga Struktur

 _{5. Ketidakfungsian keluarga}

 _{- gagal melaksanakan tujuan membina keluarga yang}

sihat (Colapinto, 1991).

 _{- enmeshed families, disenggaged families, families}

with a peripheral (dayus/ tidak berguna) male, families with juvenile parents.

SIMBOL Peta Keluarga

Terapi Keluarga Struktur

 _{Working with spontaneous interaction}  _{Boundary formation}

 _Intensity

 _{Restructuring}

 _{Shaping competence}  _Diagnosing.

Terapi Keluarga Struktur

 _{Unik aspek}

 _{1.Versatility –( fleksibiliti) pelbagai jenis keluarga.}  _{2. Nyah simtom dan menyusun semula organisasi}

keluarga.

 _{3. Pragmatik , penyelesai-masalah.}  _Kekurangan

Terapi Keluarga Strategik

 _{Kenali juga sebagai brief therapy ( ambil masa yang}

pendek)

 _{Hasil kerja Milton Erickson – Matlamat ialah}

perubahan dengan menggunakan sumber milik klien dan merekabentuk “strategi for each specific

problem”

 _{4 jenis pendekatan:}

 _{a. The mental research institute (MRI)}

 _{b. The Family or Haley-Madanes, Institute}  _{c. The Milan System Group}

 _{d. the Brief Therapy Center – solution focused}

 _{Tokoh : Jay Haley, Paul Watzlawick, John Weakland,}

Terapi Keluarga Strategik

 _{Idea Jay Haley (1973)}

 _{Paling berpengaruh dalam terapi keluarga, mendapat didikan}

dari Milton, BatesonGregory, dan Minuchin.

 _Tesis:

 _{Terapi jangka pendek, 10 sesi.}

 _{Mempunyai ciri-ciri brief therapy – “}  _{what need to be to be changed”}

 _{Fokus kepada matlamat, masalah, bertujuan menjawab}

sungutan klien.

 _{Inervensi ialah mengubah organisasi keluarga agar presenting}

problem atau simptom lenyap.

 _{Perubahan keluarga tidak melalui celik akal tetapi melalui}

Terapi Keluarga Strategik

 _{In this approach, the therapist considers the therapy in}

terms of step-by-step change in the way from one type of abnormal organisation to another type before a more normal organisation is finally achieved. For a strategic therapist two questions are basic: How is the symptom “helping” the family to maintain a balance or overcome a crisis? How can the symptom be replaced by a more effective solution of the problem?

 _{Memfokuskan kepada mendefinisikan masalah}

keluarga, menghubungkannya dan menyelesaikan

 _{Developed strategies designed to outwit resistance and}

provoke families into changing with or without their cooperation

Terapi Keluarga Strategik



_{Memfokus kepada dimensi keluarga seperti:}

Peraturan keluarga, homeostasis, quid pro

quo, prinsip redundancy, punctuation,

hubungan simetrikal dan komplementari,

sebebaban circular

Terapi Keluarga Strategik

_Teknik:

1. Reframing

2. Directives

_{3. Paradox}

_{4. Ordeals}

_{5. Pretend}

_{6. Positioning}

Systemic

 _{Systemic Family Therapy, atau Milan Model, memfokus pendekatan prescriptive}

and paradoxical berdasarkan sistem teori. Mara Selvini-Palazolli and her

associates di Milan, Itali, mencipta keadah ini.

 _{Fokus: mengalakkan keluarga melihat masalah dengan perspektif yang}

berlainan dan bukan hanya mengubah tingkahlaku.

 _{Milan Systemic Therapy (Boscolo et al, 1987)}

 _{Basic assumption of Milan Systemic Therapy is that mind is social. The}

symptomatic behaviour is conceived as a part of the transactional

patterns of the system. Significance of any particular behaviour or event may be derived from its social context. The therapists consider that the way to eliminate the symptom which is present in the family is to change the rules and beliefs. Change is achieved in clarifying the ambiguity in relationships.

Menggunakan team interview with two members of the team conducting the interview while other member, of the team observe from behind a two-way mirror.

Communications / Experimental

 _{The work of Virginia Satir, and Carl Whitaker. These two pioneer family}

therapists are unique and distinct.

 _{Conjoint Family Therapy (Satir, 1967)}

 _{Conjoint family therapy works with personal experiences and helps}

experiencing the value of the individual within the family system. Therapists use all levels of communication to express the relational qualities present in the family to achieve change in family system. This approach uses many feeling and communication exercises and games, for example family sculpture.

 _{Masalah keluarga berpunca daripada tekanan perasaan, kurang}

kesedaran, tidak ada perasaan (emotioanl deadness), penafian, penggunaan mekanisma bela diri yang terlampau. mechanisms

 _{Fokus: Komunikasi dalam keluarga dan menekankan rawatan yang}



_{Matlamat terapi : fokus kepda sensitiviti dan}

luahan perasaan , verbal dan nonverbal (role

play, mime (act out),

Behavioral, cognitive FT

 _{Behavioral, cognitive, and affective common factors in MFT.}

Behavioral regulation occurs in MFF when therapists facilitate change in clients through, for example, changing interactional patterns, modifying boundaries, changing family structures, and helping clients to learn new skills. Cognitive mastery occurs in MFT when therapists, for instance, help clients to gain insight about interactional processes within themselves, the family, between the family and other systems, and across generations (Wampler, 1997). An example of affective regulation or

experiencing is when therapists facilitate the emotional

connections that clients make with themselves, the therapist, and (most importantly) with each other.

Teknik Asas Terapi Keluarga



_Genogram



The Family Floor Plan

Reframing



_Tracking



_{Communication skill-building}

_{Family Sculpting}

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_{Family photos}

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_{The Empty chair}

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Family Choreography (step designs ,lakunan)

Family Council meeting

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_{Strategic Alliances}



_{Prescribing Indecision}