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A Primer on Family Therapy

Created by Dr. Nick Cornett
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Nick Cornett

on 2 September 2015

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Transcript of A Primer on Family Therapy

Family therapy is called family therapy because of whom you work with: families.
Entropy / Negentropy
Equifinality / Equipotentiality
First-order change / Second-order change
Feedback loops: Positive / Negative
Homeostasis
Isomorphism
Morphogenesis / Morphostasis
Open system / Closed system
wholes-focused, 1+1=3

circular causality, effect-and-effect

"the system": the context of the problem

how what is seen is a reflection of what is seen

interpersonal patterns

present-focused
National Institute of Mental Health (NIMH)
A primer on family therapy
Nick Cornett, PhD, LMFT, LPC
NCornett@jbu.edu
Assistant Professor
John Brown University

parts-focused, 1+1=2

linear causality, cause-and-effect

"the root": the content of the problem

how what is seen is a reflection of what is unseen

intrapersonal patterns

past-focused
Intrapersonal
Interpersonal
psychoanalysis
cognitive / CBT / REBT
Person-centered
Adlerian
constructivist
Less Systemic
Behaviorism
More Systemic
Intergenerational
Structural
Experiential
Strategic
MRI Brief Therapy
Milan
Bowen, Nagy
Generational patterns
Insight
Genograms
McGoldrick et al. (1999). Genograms: Assessment & Intervention
Whitaker, Satir, EFT
Patterns of expression
Emotion, Insight
Drama
Napier & Whitaker (1978). The family crucible
narrative/conversational
Minuchin
Patterns of organization
Behavior
Enactment, restructuring
Minuchin & Fishman (1981). Family therapy techniques
White, Epston / Anderson, Goolishian
Patterns of discourse
Constructions
Re-storying
White & Epston (1990). Narrative means to therapeutic ends
Haley, Madanes
Patterns of communication
Behavior
Directives, paradox
Haley (1976). Problem-solving therapy
Jackson, Fisch, Weakland, Watzlawick
Patterns of communication
Behavior
Reframing, prescribing "more-of-the-same"
Watzlawick et al (1974). Change: Principles of problem formation and problem resolution.
Boscolo, Cecchin, Palazzoli, Prata
Patterns of communication
Behavior
Circular ?s, + connotation
Boscolo et al (1987). Milan systemic family therapy
"individual therapies"
"family therapies"
Key Figures:
Focus of Change:
Mover of Change:
Primary Techniques:
Must-have Resource:
solution-focused
de Shazer, Berg
Patterns that are going well
Behavior/Constructions
Exceptions, Scaling ?s
Walter & Peller (1992). Becoming solution-focused in brief therapy
general system concepts:
references/resources

Single chapters
Fall, K. A., Holden, J. M., & Marquis, A. (2010). Systems approaches. Theoretical models of counseling and psychotherapy (2nd ed.; pp. 387-432). New York, NY: Routledge.
Goldenberg, I., Goldenberg, H., & Pelavin, E. G. (2010). Family therapy. In R. J. Corsini, & D. Wedding (Eds.), Current psychotherapies (9th ed.; pp. 417-453). Belmont, CA: Brooks/Cole.
Texts
Everett, C. A. (2000). Family therapy glossary. Washington, DC: AAMFT.
Gehart, D. R. (2010). Mastering competencies in family therapy: A practical approach to theories and clinical case documentation. Belmont, CA: Brooks/Cole.
Gehart, D. R., & Tuttle, A. R. (2003). Theory-based treatment planning for marriage and family therapists. Pacific Grove, CA: Thomson.
Goldenberg, H., & Goldenberg, I. (2007). Family therapy: An overview (7th ed.). Belmont, CA: Brooks/Cole.
Nichols, M. P. (2013). Family therapy: Concepts and methods (10th ed.). Upper Saddle River, NJ: Prentice Hall.
Watzlawick, P., Bavelas, J. B., & Jackson, D. D. (1967). Pragmatics of human communication. New York, NY: Norton.

linear systemic
HISTORY
Freud
Harry Stack Sullivan
EARLY FAMILY LIFE DETERMINES PERSONALITY


BECAUSE THE FAMILY "CAUSED" THE PROBLEM IN THE CLIENT'S EARLY LIFE, WHY WOULD WE WANT THEM IN THERAPY TOGETHER (Nichols, 2013)?
PEOPLE ARE THE PRODUCTS OF "RELATIVELY ENDURING PATTERNS OF RECURRENT INTERPERSONAL SITUATIONS" (SULLIVAN, 1953, P. 10).

MOVING BEYOND WHAT WAS INTERNALIZED (PAST) FROM THE FAMILY TO WHAT IS BEING EXTERNALIZED (PRESENT) IN RELATIONSHIPS
EARLY FAMILY LIFE SHAPES PERSONALITY...THE INDIVIDUAL INTERNALIZES WHAT OCCURS IN THEIR EARLY FAMILY RELATIONSHIPS, WHICH IMPACTS THEIR FUNCTIONING LATER IN LIFE

BECAUSE WE ARE INTERESTED IN THE "FAMILY-AS-REMEMBERED (OR PERCEIVED)" AS OPPOSED TO THE ACTUAL FAMILY AS THEY ARE CURRENTLY, WHY WOULD WE WANT THEM IN THERAPY TOGETHER (Nichols, 2013)?
Neo-Freudians
FAMILY THERAPY
Don Jackson
Research on Schizophrenia
General System Theory, Cybernetics, & Milton Erickson
Murray Bowen
Theodore Lidz
Gregory Bateson
Yale
(1950s) FAMILY EMOTIONAL SYSTEM: OBSERVED THE INFLUENCE OF EMOTIONAL INTENSITY IN THE INTERACTIONS BETWEEN FAMILY MEMBERS (TRIANGLES, EMOTIONAL REACTIVITY, UNDIFFERENTIATED FAMILY EGO MASS)
LYMAN WYNNE CONTINUED RESEARCHING AND THEORIZING ABOUT THE CONFUSING COMMUNICATION PATTERNS IN THESE FAMILIES
(1957) FOUND PATTERNS OF MARITAL DISCORD COMMON IN FAMILIES IN WHICH A MEMBER HAD SCHIZOPHRENIA
Mental Research Institute (MRI)
Salvador Minuchin
Nathan Ackerman
Family Process, 1st journal
STARTED IN 1959 BY DON JACKSON
APPLYING THEORY/RESEARCH TO BRIEF/STRATEGIC THERAPY APPROACH
MAINSTAYS: PAUL WATZLAWICK, JOHN WEAKLAND, RICHARD FISCH
OTHERS W/ INVOLVEMENT: JAY HAYLEY, VIRGINIA SATIR, STEVE DE SHAZER
Milton Erickson
USED UNCONVENTIONAL METHODS OF COMMUNICATION (HYPNOsIs) TO BRING ABOUT RAPID CHANGE

CONSULTANT TO BATESON'S RESEARCH TEAM AND A SPEAKER AT THE FIRST MACY MEETING (1942)
Ludwig von Bertalanffy
(1940s) BIOLOGIST WHO FORMULATED A UNIVERSAL THEORY (GENERAL SYSTEM THEORY) FOR EXPLAINING WHAT OCCURS BETWEEN PARTS THAT MAKE UP SYSTEMS.

HE APPLIED GENERAL SYSTEM CONCEPTS FROM THE ATOMIC LEVEL TO THE COSMIC LEVEL, SEEING HOW PARTS OF SYSTEMS RELATED TO ONE ANOTHER TO FORM A GREATER WHOLE AND HOW THESE SYSTEMS RELATED TO OTHER SYSTEMS.
General System Theory
Cybernetics & The Macy Conferences
NORBERT WIENER, CYBERNETICS ("STEERSMAN"): THE SCIENCE OF COMMUNICATION/CONTROL OR FEEDBACK - HOW ACTIVITIES IN A SYSTEM GOVERN THE SYSTEM IN SELF-CORRECTING MANNER

THE ORIGINAL MACY MEETING (1942) & CONFERENCES (1946-1953) BROUGHT TOGETHER SCIENTISTS, PSYCHOLOGISTS, MATHEMATICIANS, ENGINEERS, AND ANTHROPOLOGISTS INTERESTED IN APPLYING CYBERNETIC THEORY IN THEIR DISCIPLINES AND BEYOND.
Carl Whitaker
Virginia Satir
Jay Haley
Murray Bowen
General systems theory underlies all of the early family therapy models to some degree
Haley & Weakland were sent to observe and learn from Milton Erickson while researching as part of the Bateson Project and continued after forming the MRI.
ORIGINAL PIONEERS OF FAMILY THERAPY: COLLECTION OF INDIVIDUALS WHO HELD SYSTEMIC VIEWS OF PROBLEMS AND STARTED WORKING WITH FAMILIES CONJOINTLY AND DEVELOPING THEIR OWN THEORIES/MODELS
Steve de Shazer
Milan Approach
APPLYING BATESON'S IDEAS TO A BRIEF/STRATEGIC THERAPY APPROACH
PALAZZOLI, BOSCOLO, PRATA, CECCHIN
Postmodern Critique
Anderson & Goolishian
White & Epston
Johnson & Greenberg
Lynn Hoffman
MORE RECENT PIONEERS WHOSE IDEAS HAVE BEEN HEAVILY INFLUENCED BY POSTMODERN/CONSTRUCTIVIST/SOCIAL CONSTRUCTION PHILOSOPHIES
TRUTH IS RELATIVE AND CANNOT BE FULLY KNOWN

THERE IS NO SUCH THING AS VALUE-FREE SCIENCE
Constructivism/Social Constructionism
"REALITY IS CREATED THROUGH THE PROCESS OF INTERACTING WITH ONE'S ENVIRONMENT" (EVERETT, 2000, P. 8).

PRIMARILY THROUGH LANGUAGE/RELATIONSHIPS WITH OTHERS/SOCIOCULTURAL FORCES

REJECT REDUCTIONISM

REJECT THERAPIST AS "OUTSIDE" OF SYSTEM, AND SYSTEM AS "OUTSIDE" OF OTHER SYSTEMS ("2ND ORDER CYBERNETICS")
what is "family therapy" anyways?
COMMON MISCONCEPTION and A DEFINITION:
Family therapy is called family therapy because of how you view people: from a systemic frame of reference. As a result, a pure family therapist would always use a systemic approach, even with an individual.

Family therapy refers to a diverse range of therapeutic approaches that all, to varying degrees, utilize a systems-oriented (interactional) framework for understanding problems and for subsequent intervention.
"The black box": Moving away from attempting to figure out what "'really' goes on inside the box" to understanding the "function of the device in the greater system of which it is a part" (input-output) (Watzlawick, Bavelas, & Jackson, 1967, p. 44).
"we feel that a symptom is a piece of behavior that has profound effects in influencing the surroundings of a patient. A rule of thumb can be stated in this connection: where the why? of a piece of behavior remains obscure, the question what for? can still supply a valid answer" (Watzlawick, Bavelas, & Jackson, 1967, p. 45).
"While in linear, progressive chains of causality it is useful to speak about the beginning and end of a chain, these terms are meaningless in systems with feedback loops. There is no beginning and no end to a circle...this faulty logic is constantly used by the individual participants in human interaction when both person A and person B claim only to be reacting to the partner's behavior without realizing that they in turn influence the partner by their reaction" (Watzlawick, Bavelas, & Jackson, 1967, p. 46).
"While there can be no doubt that behavior is at least partly determined by previous experience, the search for causes in the past is notoriously unreliable...This approach, then, is a search for pattern in the here and now rater than for symbolic meaning, past causes, or motivation" (Watzlawick, Bavelas, & Jackson, 1967, pp. 44-45).
"If a person exhibiting disturbed behavior (psychopathology) is studied in isolation, then the inquiry must be concerned with the nature of the condition...If the limits of inquiry are extended to include the effects of this behavior on others, their reactions to it, and the context in which all of this takes place, the focus shifts from the artificially isolated monad to the relationship between the parts of a wider system. The observer of human behavior then turns from an inferential study of the mind to the study of the observable manifestations of relationship" (Watzlawick, Bavelas, & Jackson, 1967, p. 21).
"the whole is greater than the sum of its parts"
Distinctives
all behavior makes sense in context
"similar outcomes may result from different origins" (Everett, 2000, p. 12).
"similar origins may result in different outcomes" (Everett, 2000, p. 13).
"changes in a system may leave unaltered the underlying organization of that system" (Everett, 2000, p. 16).
"the process of change in a system which alters the fundamental organization of the system" (Everett, 2000, p. 28).
"the process whereby the influence of any event comes back to itself through other parts or events, and one point in a chain of events can reinitiate the entire chain of events" (Everett, 2000, p. 16).
more disequilibrium, changing "status quo"
less disequilibrium, restoring "status quo"
"the dynamic state of a system where one or more variables are stable and balanced" (Everett, 2000, p. 18).
"when certain structural aspects of one system match structural aspects of another system" (Everett, 2000, p. 19).
"the tendency of a system to evolve and change its structure" (Everett, 2000, p. 21).
"the tendency of a system to maintain its basic organization" (Everett, 2000, p. 11).
"systems which are continuously open to the exchange of information with its environment" (Everett, 2000, p. 22).
"systems which are self-contained and often isolated by their limited recognition and use of feedback" (Everett, 2000, p. 4).
John Bell
HEARD THAT BOWLBY WAS DOING CONJOINT WORK WITH FAMILIES, WHICH WAS NOT TRUE. BOWLBY HAD CONDUCTED ONE CONJOINT SESSION AS AN ADJUNCT TO TREATING A TEENAGER (1949)
FAMILY GROUP THERAPY (1951)
UNCONSCIOUS
THOUGHTS
FEELINGS
(Gehart & Tuttle, 2003)
(Goldenberg, Goldenberg, & Pelavin, 2010; Nichols, 2013)
The Bateson Project
WITH JAY HALEY, JOHN WEAKLAND, & WILLIAM FRY
(1956) DOUBLE-BIND: CONTRADICTORY MESSAGES WITHIN A FAMILY'S COMMUNICATION PATTERNS ACCOUNTED FOR BEHAVIOR SEEN IN SCHIZOPHRENIA
Trained in traditional, "strategic" family therapy methods
Was heavily influenced by postmodernism
Significant figure in family therapy's postmodern critique/movement
"tendency of matter to move toward randomness or an undifferentiated state" (Everett, 2000, p. 12).
"the emergence of a system's organizational patterns which leads to knowledge about the system" (Everett, 2000, p. 22).
Nick
INGREDIENTS OF A DOUBLE BIND (Gehart, 2010, pp. 147-148):

"1. Two people are in an intense relationship that has high survival value, such as a familial relation, a friendship, a religious affiliation, a doctor-patient relationship, a therapist-client relationship, or a relationship between an individual and his/her social group.

2. Within this relationship a message is given that is structured with (a) a primary injunction (e.g., a request or order) and (b) a simultaneous secondary injunction that contradicts the first, usually at the metacommunication level.

3. The receiver of the contradictory injunctions has the sense that he/she cannot escape or step outside the cognitive frame of the contradictions, either by metacommunicating (e.g., commenting on the contradiction) or by withdrawing, without threatening the relationship. The receiver is made to feel "bad" or "mad" for even suggesting there is a discrepancy."
Child psychiatrist who began exploring working conjointly with families in the mid-1940s.
Organized a session on family diagnosis at a conference, and it was here where Jackson, Bowen, Wynne, & Ackerman learned about each other's work (Nichols, 2013).


1. One cannot not communicate: All behavior is communication

2. Communication has a report (digital, content) and a command (analogic, process) level

3. To understand one's communication/behavior, it must be seen in context

4. All communicative systems are characterized by rules (unspoken norms of behavior)...
5. ...whereby homeostasis is maintained and the system preserved

6. All communicative relationships are either symmetrical or complementary

7. Everyone punctuates their reality in different ways: behavior and communication is deduced and experienced relative to the epistemology (scope or perspective) of the observer

8. Problems are maintained within the context of recursive/recurrent feedback loops of communication (interaction)
L
L
Linear vs. Systemic: "The Breakup"
message-->interaction-->patterns of interaction
"Thanks a lot"
"In the garden view of a country house, in plain view of passers-by on the sidewalk outside, a bearded man can be observed dragging himself, crouching, around the meadow, in figures of eight, glancing constantly over his shoulder and quacking without interruption. This is how the ethologist Konrad Lorenz describes his necessary behavior during one of his imprinting experiments with ducklings, after he substituted himself for the mother. 'I was congratulating myself,' he writes, 'on the obedience and exactitude with which my ducklings came waddling after me, when I suddenly looked up and saw the garden fence framed by a row of dead-white faces: a group of tourists was standing at the fence and staring horrified in my direction.' The ducklings were hidden in the tall grass, and all the tourists saw was totally unexplainable, indeed, insane behavior."
"We don't do that in our family." Why? "We just don't"
"We are in constant communication, yet we are almost completely unable to communicate about communication" (Watzlawick, Bavelas, & Jackson, p. 36)
Symmetrical: as one goes, the other goes in a similar fashion...their behaviors fit together
Complementary: as one goes, the other goes in an opposite fashion...their behaviors fit together
Wife's Punctuation: "I nag because he withdraws"
Husband's Punctuation: "I withdraw because she nags"
Alternative Punctuation: "As he withdraws, she nags, as she nags, he withdraws, as he withdraws, she nags, as she nags, he withdraws"
"...I am with you as you are with me as I am with you as you are with me..."
"The concept of report and command helps explain why couples, families, friends, coworkers, and basically any two humans can have elaborate, drawn-out arguments over taking out the trash, toilet seat lids, cat litter, toothpaste, and the recalled order of events at last night's party. These arguments, although appearing to be over 'little things,' are really about how the relationship is being defined in relation to the little things" (Gehart, 2010, p. 147).
"What's said is never heard"
COMMUNICATIONS THEORY
“If a man is shot by a poisoned arrow and says, 'Don't take this arrow away before you find out exactly by who and from where and how it was shot.' This man's death is inevitable” - Buddha
(Watzlawick, Bavelas, & Jackson, 1967, pp. 48-71)
Erickson Case Example
system: "a complex of interacting parts" (von Bertallanfy, 1968, p. 55)
“It used to be the general trend of psychology to reduce mental happenings and behavior into a bundle of sensations, drives, innate and learned reactions, or whatever ultimate elements are theoretically presupposed. In contrast, the system concept tries to bring the psychophysiological organism as a whole into the focus of the scientific endeavor (von Bertallanfy, 1968, p. 193).”
"Any organism is a system, that is, a dynamic order of parts and processes standing in mutual interaction" (von Bertalanffy, 1968, p. 208).
von Bertallanfy's (1968) caution:

“Man…is, before and above all, an individual…Human society is not a community of ants or termites, governed by inherited instinct and controlled by laws of the superordinate whole; it is based upon the achievements of the individual and is doomed if the individual is a made a cog in the social machine. This, I believe, is the ultimate precept a theory of organization can give: not a manual for dictators of any denomination more efficiently to subjugate human beings by the scientific application of Iron Laws, but a warning that the Leviathan of organization must not swallow the individual without sealing its own inevitable doom” (pp. 52-53).
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