THEORIES OF MARRIAGE AND FAMILY THERAPY

32.3.0 THEORIES OF MARRIAGE AND FAMILY THERAPY

32.3.1 Introduction
This module unit is intended to equip the trainee with knowledge, skills, attitudes and
values in the theories of marriage and family therapy. It is expected that each trainee
shall develop his/her own eclectic approach that shall suit his/her preferred orientation.

32.3.2 General Objectives

At the end of the module unit, the trainee should be able to:
a) understand the theories of marriage and family therapy
b) apply the knowledge in real life experience
c) develop own eclectic approach
d) use the skills appropriately

32.3.3 Module Unit Summary and Time Allocation

Code Sub-Module Unit Content Time
(hours)
32.3.01 Introduction to  Historical development of the 4
theories of theory
marriage and  Key figures of the theory
family therapy  Key concepts
 Therapeutic goals/therapists
function
 Techniques and practice of the
theory
 Conditions for change
32.3.02 Psycho-analytic  Historical development of the 4
theory theory
 Key figures of the theory
 Key concepts
 Therapeutic goals/therapists
function
 Techniques and practice of the
theory
 Conditions for change
32.3.03 Transgenerational  Historical development of the 4
family therapy theory
 Key figures of the theory
 Key concepts
 Therapeutic goals/therapists
function
 Techniques and practice of the
theory
 Conditions for change

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Code Sub-Module Unit Content Time
(hours)
32.3.04 Bowenian family  Historical development of the 4
therapy theory
 Key figures of the theory
 Key concepts
 Therapeutic goals/therapists
function
 Techniques and practice of the
theory
 Conditions for change
32.3.05 Experiential family  Historical development of the 4
therapy theory
 Key figures of the theory
 Key concepts
 Therapeutic goals/therapists
function
 Techniques and practice of the
theory
 Conditions for change
32.3.06 Humanistic family  Historical development of the 4
theory theory
 Key figures of the theory
 Key concepts
 Therapeutic goals/therapists
function
 Techniques and practice of the
theory
 Conditions for change
32.3.07 Structural family  Historical development of the 4
therapy theory
 Key figures of the theory
 Key concepts
 Therapeutic goals/therapists
function
 Techniques and practice of the
theory
 Conditions for change
32.3.08 Human validation  Historical development of the 4
process model theory
 Key figures of the theory
 Key concepts
 Therapeutic goals/therapists
function
 Techniques and practice of the
theory

2
Code Sub-Module Unit Content Time
(hours)
 Conditions for change
32.3.09 Behavioural family  Historical development of the 6
therapy theory
 Key figures of the theory
 Key concepts
 Therapeutic goals/therapists
function
 Techniques and practice of the
theory
 Conditions for change
32.3.10 Cognitive  Historical development of the 6
behavioural theory
family therapy  Key figures of the theory
 Key concepts
 Therapeutic goals/therapists
function
 Techniques and practice of the
theory
 Conditions for change
32.3.11 Solution focused  Historical development of the 6
therapy theory
 Key figures of the theory
 Key concepts
 Therapeutic goals/therapists
function
 Techniques and practice of the
theory
 Conditions for change
32.3.12 Eclectic approach  Historical development of the 7
theory
 Key figures of the theory
 Key concepts
 Therapeutic goals/therapists
function
 Techniques and practice of the
theory
 Conditions for change
32.3.13 Emerging issues  Emerging issues and trends in 3
and trends in theories of marriage and family
theories of therapy
marriage and  Challenges posed by emerging
family therapy issues and trends in theories of
marriage and family therapy
 Ways of coping with challenges

3
 Code Sub-Module Unit Content Time
(hours)
posed by emerging issues and
trends in theories of marriage
and family therapy
Total Time 60

32. 3. 01 INTRODUCTION TO THEORIES OF MARRIAGE AND FAMILY THERAPY

Historical Development of the Theory

Historical development of particular theories captures experiences and historical accounts that lead
to the development of particular theories. Additionally, developmental milestones of these theories
are explained through the years. The authors stipulate what informed the development of such
theories. We are able to appreciate the initial concepts and how those concepts were modified with
time.

Key Figures of the Theory

These are the main proponents of particular theorists. Such theorists maybe many or it can be just
one. They are the originators of those particular theories that they write about. Knowing about the
theorists helps the learner/counsellor in training to appreciate experiences of the theorists that
made him/her to write the systemic theory.

Key Concepts
These are the major assumptions/philosophies or constructs that define the particular theories
presented. They are the frontline ideas that the theorists put forward to either explain human
behavior or features/patterns that define systems and techniques that facilitate treatment of
individuals and systems.

Therapeutic Goals/Therapists Function

These are the objectives or aims that the therapist wants to achieve by utilizing a particular theory.
The goals become the driver of the counselling goals towards the expected outcomes. The
therapist’s role is clearly stipulated in the theory. How does the therapist communicate, establish
therapeutic boundaries, regulate power and control etc?

Techniques and Practice of the Theory

Techniques are the systemic methods that help achieve the goals outlined in particular theories. If
a goal aimed is to structure a family appropriately like in Structural family theory by Salvador
Minuchin, then strategies to help achieve that goal are put forward like sculpting or boundary

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marking. The learners are expected to practice so that they can utilize those particular techniques
in those systemic theories.

Conditions for Change

These are circumstances and situations that would promote progress or hinder therapeutic
progress. Such would include the way the therapist would join the family and the kind of a
relationship he/she would form with couples and families. Also it includes ethical considerations
the therapist bears in mind when conducting sessions.

32.3.02 PSYCHOANAYTIC THEORY

Historical Development of the Theory

The theories behind psychoanalysis and psychoanalytic therapy come from famous
psychoanalyst Sigmund Freud. During the late 1800s Freud began studying with Jean-Martin
Charcot in Paris, a neurologist who used hypnosis to treat women suffering from what at the time
was called hysteria. Charcot found that by talking to his patients about past traumatic
experiences, symptoms lessened.

When Freud continued his work apart from Charcot he went on to develop his own method of
'talk therapy'. In his work Freud established therapeutic techniques such as free association,
dream analysis and transference, many of which remain central to psychoanalysis today.
Critically, Freud's theories (especially those to do with sexuality and women) have come under
scrutiny, however much of his work remains influential in the world of psychotherapy.

In 1960s and 1970s, family therapy followed Jackson and Salvador Minuchin in not only
ignoring psychoanalytic thinking but belittling it; the psychology of the individual had lost
importance. Then in 1980s, a surprising shift occurred where therapists took a new interest in the
individual. This revival of the interest reflected changes in psychoanalysis-from individualism of
Freudian theory to the more relationship –oriented object relations theories and self-psychology.
Among books calling for a rapprochement with psychoanalysis were: Object Relations: A
Dynamic Bridge between Individual and Family Treatment (Slipp, 1984); Object Relations
Family Therapy (Scharff & Scharff, 1987); and Self in the System (Nichols, 1987). While system
therapists focused on the outward expression of this inner life family interaction and
communication-psychoanalytic therapists probed beneath family dialogues to explore individual
family member’s private fears and longings.

Key Figures of the Theory

Freud was interested in the family but saw it as old business –the place where people learned
neurotic fears, rather than the contemporary context where such fears were maintained. Many of
the pioneers of family therapy included Nathan Ackerman, Murray Bowen, Ivan Boszormenyi-
Nagy, Carl Whitaker, Don Jackson and Salvador Minuchin came from psychoanalytic tradition.
From 1930s to the 1950s, psychoanalytic researchers became more interested in the contemporary
family.

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Erik Erikson explored the sociological dimensions of ego psychology. Erich Fromm’s
observations about the struggle for individuality foreshadowed Bowen’s work on individuation
of self. Harry Stack Sullivan’s interpersonal theory emphasized the mother’s role in transmitting
anxiety to her children.

Therapeutic Goals and Therapists Function

Goals of therapy include:

a) Freeing family members of unconscious constraints so that they will be able to interact
with one another as healthy individuals.
b) Personality change
c) Separation –individuation or differentiation- both terms connote autonomy. Rather than
isolate individuals from their families, psychoanalytic therapists convene families to
help them learn how to let go of one another in a way that allows individuals to be
independent as well as related.

Key Concepts of the Theory

i) View of Human Nature

Freud’s view of human nature is considered to be dynamic, meaning that there is an exchange of
energy and transformation. Freud used the term catharsis to describe this release of this energy.
Freud saw the personality as composed of a conscious mind, a preconscious mind and an
unconscious mind. The conscious mind has knowledge of what is happening in the present.
The preconscious mind contains information from both the unconscious and the conscious
mind. The unconscious mind contains hidden or forgotten memories or experiences. When
families come to therapy they deal with unconscious material that drives their behavior in
the family.

ii) Drive Psychology

At the heart of human nature are sexual and aggressive drives. Psychoanalysis is the study of
individuals and their deepest motives (drives and need for attachment); family therapy is the
study of social relationships. The bridge between them is Object Relations Theory. We relate
with others on the basis of expectations formed by early experience. The residue of these
relationships leaves internal objects-mental images of self and others built upon experience and
expectation. In their observations of infants and young children, Rene Spitz and John Bowlby
emphasized the child’s profound need for attachment to a single and constant object. If this need
is denied, the child turns away from the world and withdraws into apathy.

Margaret Mahler observed young children went through a process of separation-individuation.

After the process of merger, the child begins a gradual process of separation from the mother,
progressively renouncing symbiotic fusion with her. The result of successful separation and
individuation is a well differentiated self. Failure to achieve individuation undermines the
development of a differentiated identity, resulting in overly intense emotional attachments.

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Parents also offer models of idealization. The little child who can believe “My mother or father
is terrific, and l am part of him/her has a firm base for self-esteem.” The child draws strength
from identifying with the strength and the power of his/her parents.

iii) Structure of Personality

The personality has three parts: the id, the ego, and the superego. The id is present at birth and is
part of the unconscious. The id is the site of the pleasure principle, the tendency of an individual
to move toward pleasure and away from pain. The id does not have a sense of right or wrong, is
impulsive, and is not rational. It contains the most basic of human instincts, drives, and genetic
endowments.

The ego is the second system to develop and it functions primarily in the conscious mind and in
the preconscious mind. It serves as a moderator between the id and the superego, controlling
wishes and desires. The ego is the site of the reality principle, the ability to interact with the
outside world with appropriate goals and activities.

The superego sets the ideal standards and morals for the individual. The superego operates on
the moral principle which rewards the individual for following parental and societal dictates.
Guilt is produced when a person violates the ideal ego denying or ignoring the rules of
the superego.

iv) Transference

Fear dictated flight from object relations which begins in childhood is now considered the
deepest root for psychological problems. One important reason for relationship problems is that
children distort their perception by attributing the qualities of one person to someone else.
Freud (1905) discovered this phenomenon and called transference when his patient Dora
displaced feelings for her father onto him and terminated treatment abruptly when it was on the
throes of success.

v) Projective Identification

Projective identification is a process whereby the subject perceives an object as if it contained

unwelcome elements of the subject’s personality and evokes responses from the object that
conform to those perceptions. Unlike projection, projective identification is an interactive
process. Not only do parents project anxiety arousing aspects of themselves onto their children,
the children collude by behaving in a way that confirms the parents’ fears. In this way,
intrapsychic conflict becomes externalized, with the parent acting as superego, punishing the
child for acting on dictates of the parental id. That’s one reason parents overact: they are afraid
of their own impulses. The Identified Patient (IP) becomes the target of parents’ projected
emotions. They collude in the projected identification in order to cement attachments, assuage
unconscious guilt or preserve the parent’s shaky marriage.

Parents’ failure to accept that their children are separate beings can take extreme forms, leading
to the most severe psychopathology. Poorly differentiated children face a crisis in adolescence,

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when developmental pressures for independence conflict with infantile attachments. When they
marry, they may seek approval; automatically reject any influence, or both. Sager (1981) offers
that each marriage contract has three levels of awareness:

a) Verbalized though not always heard.

b) Conscious but not verbalized, usually because of fear of anger or disapproval
c) Unconscious

Each partner acts as though the other ought to be aware of the terms of the contract, and is angry
if the spouse doesn’t live up to those terms. Every one of us wants our mates to conform to an
internalized model, and we are anything but understanding when these unrealistic expectations
are disappointed (Dicks, 1963).

vi) Family Myths

Myths protect family members from facing certain painful truths, and also serve to keep
outsiders from learning embarrassing facts. A typical myth is that of family harmony especially
for conflict avoiding families. Often the myth of family harmony is maintained by use of
projective identification; one family member is delegated to be the bad one, and all others insist
that they are well adjusted. This bad seed maybe the IP or even a deceased relative. These family
myths are defenses that families use to cover their faults and challenges that need to be handled
in therapy.

vii) Fixation and Regression

Most families function adequately until they are overtaxed, at which time they become stuck in
dysfunctional patterns. When faced with too much stress, families tend to decompensate to
earlier levels of development. The amount of stress a family can tolerate depends on its level of
development and the type of fixations its members have. To say that someone has acted out
repressed sexual urges through an extra marital affair is to suggest he is not accountable.
However, Ivan Boszormnyi-Nagy stresses the idea of ethical accountability in families. Good
family relationships include behaving ethically with other family members and considering each
members welfare and interests. He believes family members owe one another loyalty, and that
they acquire merit by supporting each other.

viii) Invisible Loyalties

Pathological reactions may develop from invisible loyalties-unconscious commitments children

take on to help their families to the detriment of their own wellbeing. For example, a child may
get sick to unite parents. Invisible loyalties are problematic because they are not subject to
rational awareness and scrutiny.

ix) Developmental Stages

a) Oral stage is centered on the mouth as a source of pleasure.
b) Anal stage is centered on the anus and elimination as a source of pleasure.

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 c) Phallic stage is centered on the genitals and sexual identification as a source of
pleasure.

o Oedipus complex is described as the process whereby a boy desires his mother
and fears castration from the father, in order to create an ally of the father, the
male learns traditional male roles.
o Electra complex is described a similar but less clearly resolved in the female
child with her desire for the father, competition with the mother and thus,
learns the traditional female roles.

d) Latency stage is a time of little sexual interest in Freud’s developmental view. This
stage is characterized with peer activities, academic and social learning, and
development of physical skills.
e) Genital stage begins with the onset of puberty. If the other stages have been
successfully negotiated, the young person will take an interest in and establish sexual
relationships.

x) Ego Defense Mechanisms

Freud believed they protected the individual from being overwhelmed by anxiety. He considered
them normal and operating on the unconscious level. Some of the ones most often referred to
are:

o Repression is the defense mechanism whereby the ego excludes any painful or undesirable
thoughts, memories, feelings or impulses from the conscious.
o Projection is the defense mechanism whereby the individual assigns their own undesirable
emotions and characteristics to another individual.
o Reaction Formation is the defense mechanism whereby the individual expresses the
opposite emotion, feeling or impulse than that which causes anxiety.
o Displacement a defense mechanism whereby the energy that is generated toward a
potentially dangerous or inappropriate target is refocused to a safe target.
o Sublimation is a positive displacement is called whereby the frustrating target is replaced
with a positive target.
o Regression is the defense mechanism whereby returns to an earlier stage of development.
o Rationalization is the defense mechanism in which an individual creates a sensible
explanation for an illogical or unacceptable behavior making it appear sensible or
acceptable.
o Denial is a mechanism whereby an individual does not acknowledge an event or situation
that may be unpleasant or traumatic.
o Identification is a defense mechanism whereby a person takes on the qualities of another
person to reduce the fear and anxiety toward that person.

Techniques and Practice of the Theory

There are four basic techniques: listening, empathy, interpretations and analytic neutrality

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 a) Listening: Listening is vital in family therapy where therapists feel a tremendous
pressure to do something to help troubled families.
b) Analytic neutrality: you concentrate on understanding without worrying about solving
problems. Change may come as a byproduct of understanding, but the analytic therapist
suspends anxious involvement with outcomes
c) Empathy: The analytic therapist resists the temptation to be drawn in to reassure advice
or confront families in favor of sustained, but silent immersion in their experience to help
families understand their interactions and experiences.
d) Interpretation: When analytic therapists do intervene, they express empathy in order to
help family members to open up, and make interpretations to clarify hidden aspects of
experience. Therapists organize their explorations with couples along four lines: internal
experience; history of that experience; how the partner triggers that experience and how
the context of the session and therapist might contribute to what’s going on between the
partners.

Conditions for Change

a) In psychoanalytic family therapy, family members expand their insight by learning that
their psychological lives are larger than their conscious experience, and by coming to
accept their repressed personalities. Insights achieved must be worked through and
translated into new and productive ways.
b) Through insight, defenses are reduced and family members become more truly
themselves through stopping to resist their unconscious needs by allowing analysis and
constructive ways of meeting those needs
c) Analytic therapists foster insight by looking beyond behavior to the hidden motives
below. Once an atmosphere of security is established, the analytic therapist can begin to
identify projective mechanisms and bring them back into marital relationship. Therapists
helps couples begin recognizing how their present difficulties emerged from unconscious
perpetuation of conflicts from their own families.

Bibliography

1) Dicks, H.V. 1963. Object relations theory and marital studies. British Journal of Medical
Psychology. 36: 125-129
2) Nichols, M.P. 1987. The Self in the System. New York: Brunner/Mazel
3) Sager, C.J. 1981. Couples therapy and marriage contracts. In Handbook of family
therapy, A.S. Gurman and D.P. Kniskern, eds. New York: Brunner/Mazel
4) Scharff, D. and Scharff, J. 1987. Object relations family therapy. New York: Jason
Aronson.
5) Slipp, S. 1984. Object relations: A dynamic bridge between individual and family
treatment. New York: Jason Aronson.

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32.3.03 TRANSGENERATIONAL FAMILY THERAPY

Historical Development of the Theory

Transgenerational therapy typically involves helping people learn to recognize emotional

patterns that lead to triangulation, through more insight into how they learned these patterns
through transgenerational transmission. Understanding how a family works and interacts is the
key objective of a therapist. During the last seven decades, the family therapy movement has
tried to understand the mystery and beauty of the family. From psychoanalysis to the narrative
school, every single school has discovered a new facet of the family.

Psychoanalysis uncovered how unresolved conflicts from the past continue to affect the family in
the present (Goldenberg & Goldenberg, 2004). Bowen’s school introduced the hypothesis that
many mental illnesses are the result of dysfunctional patterns in the family system (Nelson,
2003). That is why he was one of the first to treat the whole family and their emotional system
instead of the single member and his or her personal emotions or behaviors. Besides this
important innovation, the Bowen’s concepts of triangulation and transgenerational patterns have
provided an important tool to help clients to identify the root of many family problems and a way
to break those cycles (McGoldrick, & Carter, 2001).

Experiential family therapists discovered how the emotional process in which a person is
involved matters to the patient. They focused on the individual growth and development of the
person’s self-esteem, which is one of the most basic and primary concepts of a human being. On
the other hand, the Cognitive-Behavioral Family Therapist postulated that an illogical belief
works as the principal stressors and triggers for the family’s emotional distress (Nichols, 2009).
Both schools, the first dealing with the family’s emotions, and the second dealing with the
beliefs and schemas, have provided a unique advance to the understanding of the interactions
within the family.

In addition to the above mentioned family therapy schools, structural family therapy has
contributed with the concepts of family hierarchy and boundaries, which has introduced to the
notion of family a new and organized strategy to deal with the family dynamic (Nichols, 2009).
Post-modernism has contributed with a more multi-cultural and social view of the
family’s reality. For instance, narrative therapy stressed the importance of discussing how
oppressive narratives are dominating the family’s way of living and how the family can be
liberated from them by re-authoring their own stories.

Key Figures of the Theory

Murray Bowen: As Goldenberg and Goldenberg (2004) stated, Murrary Bowen’s model framed
the presenting problem within the past and present and stressed the importance of family
relational patterns. These relational patterns have a strong influence over the lives of a person
and their family to the extent that noticing them is crucial in order to become a differentiated
person, which by definition is a person that has the “capacity to think and reflect, to not respond
automatically to emotional pressure, internal or external” (Nichols, 2009, p. 87). The concept of

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differentiation of self is a key element in therapy. Through this concept, the therapist can assess
the patient’s capability to preserve a strong sense of selfidentity while maintaining the natural
attachment to his/her family system (Nelson, 2003).

Differentiation of self is interrelated with the notion of emotional triangles. In Bowen’s theory, a
triangle is a three-person relationship structure, which can be considered as the fundamental part
of a larger emotional system. Kerr (1994) stated that a triangle “is the smallest stable relationship
unit” (p. 393) which is created when a tense situation or an unresolved problem between two
people cannot find a solution, so one of the affected persons turns to a third individual in search
for understanding, or a way to fix the crisis.

B C

McGoldrick and Carter: They advanced the development and use of family genograms. By
using the Genogram, the therapist can help the family to assess their own family of origin,
discovering patterns of behavior and triangles and measuring their own self-differentiation. By
doing so, the family will be able to reach the principal goals of the therapy which are the
differentiation of themselves and de-triangulation (Nelson, 2003). The Genogram is a kind of
family map that goes to the third or fourth generation. The most important part in a Genogram is
to discover the “emotional dynamics of the family” (Nelson, 2003, p. 267) and the patterns in
behaviors. McGoldrick, and Carter (2001) emphasized that a Genogram is a way to map the
family history, “which should not be treated as a form to fill out, but rather as a framework for
understanding family patterns” (p. 286).

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Salvador Minuchin: In the process of making the Genogram, a therapist may realize that every
single family unit has a structure and may also notice certain patterns of organization (Nicholas,
2009). The structure shown in the Genogram can be used to understand how a specific family
unit acts. This is the point where the structural family model comes into play. Even though the
structural school does not focus its attention in the root and history of the problem (Wetchler,
2003), the conceptualization of patterns of behavior and how the family system has tried to
resolve the problem, is a fundamental predicament in the theoretical framework of the structural
school. Salvador Minuchin’s approach to family therapy stated that the focus of therapy is not
the individual but the person within the family (Minuchin, 1974). The focus is not only in the
past, how they try to solve the problem, but mainly in the present, in how the family is trying
now to solve it (Goldenberg & Goldenberg, 2004). According to Nichols (2009), the structural
model has three essential theoretical components: the family structure, the family subsystems
and the family boundaries.

family subsystems

Spousal Sub system

Sibling sub system

Parental sub system

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Generational sub system
Key Concepts

How does a family maintain and pass on its unique identity and culture? What goes into the
passage of family tradition from one generation to the next? It took many years for biologists to
tease out the rules which govern the biosocial communication between generations. Genetics is
the science built from those rules. It deals with the method by which biological information is
passed from parent to offspring. Information from previous generations is now known to be
communicated via amino acid codes contained in a complex DNA molecule which is physically
duplicated in the new organism.

Transgenerational theory attempts to highlight areas involved in the communication of acquired

practices, behaviours and beliefs between generations. There is no developed science at present
in this area which details rigorous laws governing the passage of family culture and tradition.

Inherited, Moulded and Constitutive Features: Human beings are born into the world with
very little more than their inherited (genetic) tendencies, traits, and physical make-up. Evidence
for the existence of the moulding of individuals in their early life is abundant. In the
developmental theories of analytical psychologies, many of them postulate periods of
psychological developmental stages which begin at birth and last until the ages between six and
eight.

The rapidly developing science of ethology, the science of the study of natural animal behaviour,
has provided a parallel concept to that of the analytic psychologies. Imprinting is a phenomenon
that imposes certain behaviour patterns on individuals by very early exposure to a given
stimulus. But although analytical psychologies discovered the existence and importance of
developmental stages and ethologists have delineated more clearly the rules governing this
imprinting process, neurobiology has provided some physical evidence for this qualitative
difference in learning. The second category of acquired features is those which are acquired in
later life through associational learning. Associational learning occurs throughout the remaining
life of the individual and includes emotional, experiential and cognitive learning.

Transgenerational Passage: Within the family all forms of learning affect the developing child.
A child may have moulded into him the relationship influences within the family which are
constitutive for the rest of the family, as well as moulded characteristics which are passed down
from previous generations. These influences may be directly handed down as original to the
family of origin or they may be indirectly received through those nuclear family members. Direct
influence also occurs between the developing child and the extended family. Direct moulding
occurs when a developing child is brought into contact with any of the existing personalities in
the nuclear and extended family constellation. For example, consider the way in which a child
may be taught to control his anger. He may be spanked, isolated in his room, frostily ignored,
silently condemned, or even encouraged openly or subtly to continue his tantrum by any family
member. Any of these reactions carries with it a model upon which the child will base his own
future reactions as well as a model of the way in which adults train children to control their
anger.

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The Passage of Behaviour, Belief, and Tradition: Transgenerational passage is a concept that
incorporates the transmission of the entire gamut of family-related traditions, beliefs, and
behaviours. The passage of family beliefs incorporates attitudes towards life, death and sexuality.
Choice of occupation and educational aspirations, attitudes towards money, politics, and attitudes
towards other families and cultures are also passed on. The hopes of the older generation may be
passed on to become the accomplishments of the following generations.

Family roles, such as what fathers do as opposed to what mothers do, how close or distant
grandmothers or grandfathers are to their grandchildren, whether extended family ties are close
or distant, are passed on as beliefs as well as practices or behaviours. Even the determination of
who constitutes an extended family member is passed on as a behaviour. Family conflicts are
also passed from one generation to the next. At times the conflict is already moulded into an
individual family member such as father, mother, uncle or grandparent and passed on as a model
of conflicting and contradictory behaviour within the relative. In order to understand a particular
family's quandary, the specific traditions, beliefs, and behaviours of that family must be
ascertained through the exploration of that particular family's history.

Bonds and Bonding: Bonds are defined as the emotional attachment between two or more
individuals. Bonds are what distinguish family members from 'outsiders'. Bonded individuals
remain close to each other emotionally despite geographic distance. They attempt to maintain
contact through visits, letters, and phone calls, but even if permanently separated physically,
bonded individuals can remain attached to each other. Because bonds are forged emotionally,
most of our strongest emotions arise during the formation, maintenance, renewal and disruption
of bonds. Because family quandaries are often emotional problems, an understanding of bonds
and bonding within the particular family is necessary.

Families in Collision: The Choice of a Spouse: Most family therapists acknowledge the critical
role that the marital coalition plays in determining the viability of a family. The emotional,
sociological, and interpersonal forces in marital choice are of vital interest in the investigation of
any family quandary.

Marital choice is first limited by the field of eligibility. Geographical location, social class, age,
race, religion, incest taboos and physical parameters such as appearance, height and weight all
serve to narrow the field of eligibility of marital choice. The influence of the parental image in
the conscious determination of the choice of spouse has been confirmed in several studies.
Patterns of choice have been uncovered in which the spouse is chosen based on the image of the
parent of the opposite sex, the parent of the same sex, or a combination of traits possessed by
both parents. Another important pattern has been reported in which the choice of a spouse is
based on the complete opposite of a parental figure. A parental image is defined not in terms of
facial features, but in terms of parental personality, opinions and temperament. In general, a
person tends to fall in love with someone who resembles the parent with whom he was most
closely bonded as a child. Secondarily, a person is attracted to a choice of a partner possessing
opposing characteristics to a parent with whom an unsatisfactory relationship existed as a child.

Family pressure does not only exert itself towards seeking a particular match. Pressure may be
exerted from one or both families of origin to prevent a match. Here the outcome depends on the

15
strength of valency of the couple and the way in which the family pressure is reacted to by each
of the partners. If they react by resenting any attempt of their family to limit their independence
the pressure may actually increase the likelihood of a match.

Family Losses, Family Replacements: Life events research confirms that exits or losses from
the social field precede the development of stress in individuals which can lead to psychiatric
symptomatology. The death of a family member is ranked as the most stressful of life events that
families and their individual members must face. It is an immediate and irrevocable disruption in
the continuity of family life and often sends a shock wave travelling through the entire extended
family network. A family culture must be able to survive beyond the death of its individual
members in order to maintain its integrity as an organic whole. Such survival must take into
account the natural reaction of its members to loss.

If the family members are unable to mourn separately or collectively a family pattern develops
which is then perpetuated through transgenerational passage. Changes in family structure
become less fluid and there is an attempt to freeze the generational hierarchy of the family
against the passage of time and the family's normal evolution. This attempt at a family stasis is
accomplished through the shifting of the bond from the deceased to another member of the
family who acts as a replacement for the deceased. Acceptance of grieving as a normal activity
leads to a family style of acceptance of these less traumatic life events which contain similar
mixed negative and positive feelings.

Family Secrets: Family secrets are those behaviours, beliefs, traditions, or feelings which cannot
be openly communicated between family members. Not only does each particular secret bit of
information exist in itself, but there is continuum of family secrecy which pervades a family
culture. A particular secret may be trivial but there are secrets in families which have a profound
effect on the entire family network.

Secrets can develop out of a sense of fear, guilt, or shame as well as out of a sense of belonging
to an exclusive group. The fear is related to the presumed consequences of the revelation of the
secret; this revelation might prove the destruction of the organisation and structure of the family
unit. The expulsion of the member who dared to start the communication process might occur.

Family Evolution: Family evolution refers to the change in family culture as it is passed down
from generation to generation. Family beliefs, practices and traditions which have been handed
down through the generations alter and change.

A family evolves over the generations as a result of change in the physical, social and cultural
environment as well as through internal idiosyncrasies and hybridisation. New knowledge can be
widely disseminated and put to use using modern communication methods. Such knowledge
which leads to changes in beliefs and practices can instill new traditions within a family
overnight. One need only look at the effect of the exposure of previously isolated primitive tribes
(which are usually composed of several large extended families) to Western culture and its
beliefs and practices. Within one generation many customs are loss and by three or four
generations most of them have ceased to be memories. Family evolution provides a concept in
which the differentiation of children from their parents can be seen in a broader perspective.

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Therapeutic Goals/Therapists Function
a) Tries to lower anxiety (which breeds emotional fusion) to promote understanding, which
is the critical factor in change; open conflict is prohibited as it raises the family members'
anxiety during future sessions
b) Remains neutral and detriangulated, and in effect models for the parents some of what
they must do for the family
c) Promotes differentiation of members, as often a single member can spur changes in the
larger family; using "i" statements is one way to help family members separate their own
emotions and thoughts from those of the rest of the family
d) Develops a personal relationships with each member of the family and encourages family
members to form stronger relationships too
e) Encourages cut off members to return to the family
f) May use descriptive labels like "pursuer-distancer," and help members see the dynamic
occurring; following distancers only causes them to run further away, while working with
the pursuer to create a safe place in the relationship invites the distancer back.
g) Coaches and consults with the family, interrupts arguments, and models skills..

Techniques and Practice of the Theory

The genogram: The genogram, a technique often used early in family therapy, provides a
graphic picture of the family history. The genogram reveals the family's basic structure and
demographics. Through symbols, it offers a picture of three generations. Names, dates of
marriage, divorce, death, and other relevant facts are included in the genogram. It provides an
enormous amount of data and insight for the therapist and family members early in therapy. As
an informational and diagnostic tool, the genogram is developed by the therapist in conjunction
with the family.

The family floor plan: The family floor plan technique has several variations. Parents might be
asked to draw the family floor plan for the family of origin. Information across generations is
therefore gathered in a nonthreatening manner. Points of discussion bring out meaningful issues
related to one's past.

Reframing: Most family therapists use reframing as a method to both join with the family and
offer a different perspective on presenting problems. Specifically, reframing involves taking
something out of its logical class and placing it in another category. For example, a mother's
repeated questioning of her daughter's behavior after a date can be seen as genuine caring and
concern rather than that of a nontrusting parent. Through reframing, a negative often can be
reframed into a positive.

Tracking: Most family therapists use tracking. Structural family therapists see tracking as an
essential part of the therapist's joining process with the family. During the tracking process the
therapist listens intently to family stories and carefully records events and their sequence.
Through tracking, the family therapist is able to identify the sequence of events operating in a
system to keep it the way it is. What happens between point A and point B or C to create D can
be helpful when designing interventions.

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Communication skill-building techniques: Communication patterns and processes are often
major factors in preventing healthy family functioning. Faulty communication methods and
systems are readily observed within one or two family sessions. A variety of techniques can be
implemented to focus directly on communication skill building between a couple or between
family members. Listening techniques including restatement of content, reflection of feelings,
taking turns expressing feelings, and nonjudgmental brainstorming are some of the methods
utilized in communication skill building.

In some instances the therapist may attempt to teach a couple how to fight fair, to listen, or may
instruct other family members how to express themselves with adults. The family therapist
constantly looks for faulty communication patterns that can disrupt the system.

Family sculpting: Family sculpting provides for recreation of the family system, representing
family members’ relationships to one another at a specific period of time. The family therapist
can use sculpting at any time in therapy by asking family members to physically arrange the
family. Adolescents often make good family sculptors as they are provided with a chance to
nonverbally communicate thoughts and feelings about the family. Family sculpting is a sound
diagnostic tool and provides the opportunity for future therapeutic interventions.

Family photos: The family photos technique has the potential to provide a wealth of information
about past and present functioning. One use of family photos is to go through the family album
together. Verbal and nonverbal responses to pictures and events are often quite revealing.
Adaptations of this method include asking members to bring in significant family photos and
discuss reasons for bringing them, and locating pictures that represent past generations. Through
discussion of photos, the therapist often more clearly sees family relationships, rituals, structure,
roles, and communication patterns.

Special days, mini-vacations, special outings: Couples and families that are stuck frequently
exhibit predictable behavior cycles. Boredom is present, and family members take little time
with each other. In such cases, family members feel unappreciated and taken for granted. "Caring
Days" can be set aside when couples are asked to show caring for each other. Specific times for
caring can be arranged with certain actions in mind.

The empty chair: The empty chair technique, most often utilized by Gestalt therapists has been
adapted to family therapy. In one scenario, a partner may express his or her feelings to a spouse
(empty chair), then play the role of the spouse and carry on a dialogue. Expressions to absent
family, parents, and children can be arranged through utilizing this technique.

Family choreography: In family choreography, arrangements go beyond initial sculpting;

family members are asked to position themselves as to how they see the family and then to show
how they would like the family situation to be. Family members may be asked to reenact a
family scene and possibly resculpt it to a preferred scenario. This technique can help a stuck
family and create a lively situation.

Family council meetings: Family council meetings are organized to provide specific times for
the family to meet and share with one another. The therapist might prescribe council meetings as

18
homework, in which case a time is set and rules are outlined. The council should encompass the
entire family, and any absent members would have to abide by decisions. The agenda may
include any concerns of the family. Attacking others during this time is not acceptable. Family
council meetings help provide structure for the family, encourage full family participation, and
facilitate communication.

Strategic alliances: This technique, often used by strategic family therapists, involves meeting
with one member of the family as a supportive means of helping that person change. Individual
change is expected to affect the entire family system. The individual is often asked to behave or
respond in a different manner. This technique attempts to disrupt a circular system or behavior
pattern.

Prescribing indecision: The stress level of couples and families often is exacerbated by a faulty
decision-making process. Decisions not made in these cases become problematic in themselves.
When straightforward interventions fail, paradoxical interventions often can produce change or
relieve symptoms of stress. Such is the case with prescribing indecision. The indecisive behavior
is reframed as an example of caring or taking appropriate time on important matters affecting the
family. A directive is given to not rush into anything or make hasty decisions. The couple is to
follow this directive to the letter.

Putting the client in control of the symptom: This technique is widely used by strategic family
therapists and places personal control in the hands of the individual or system. The therapist may
recommend, for example, the continuation of a symptom such as anxiety or worry. Specific
directives are given as to when, where, and with whom, and for what amount of time one should
do these things. As the client follows this paradoxical directive, a sense of control over the
symptom often develops, resulting in subsequent change.

Conditions for Change

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

19
identify as psychodynamic, object relations, intergenerational, or experiential family therapists
(EFTs)—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. It is important to note that a circular way of
problem evaluation is used as opposed to a linear route. Using this method, families can be
helped by finding patterns of behaviour, what the causes are, and what can be done to better their
situation.

Bibliography

Goldenberg, H. & Goldenberg, I. (2004). Family therapy: An overview. Belmont, CA: Thomson.
Griffin, W.A. & Greene, S.M. (1999). Models of family therapy, the essential guide.
Philadelphia, PA: Brunner/Mazel.
Kerr, M.E. (1994). Murray Bowen: Family therapy in clinical practice. In S. Crow and H.
Freeman (Eds.), The book of psychiatric books (pp. 389-396). New York, NY: Jason Arson Inc.
McGoldrick, M. & Carter, C. (2001). Advances in coaching: Family therapy with one person.
Journal of Marital and Family Therapy, 27(3), 281-300.
Minuchin, S. (1974) Families and family therapy. Cambridge, Massachusetts: Harvard
University Press.
Nelson, T.S. (2003). Transgenerational family therapies, In L.L. Hecker & J.L. Wetchler (Eds.),
An introduction to marriage and family therapy, (pp. 255-285) New York, NY:. The Haworth
Clinical Press.
Nichols, M. (2009). The essentials of family therapy, Boston, Massachusetts: Person Education,
Inc.
Wetchler, J.L. (2003). Structural family therapy, In L.L. Hecker & J.L. Wetchler (Eds.), An
introduction to marriage and family therapy, (pp. 63-94). New York, NY: The Haworth
Clinical Press.

32.3. 04 BOWENIAN FAMILY THERAPY

Historical Development of the Theory

In the mid 1950’s several psychiatrists working independently began treating families with an
emotionally disturbed member; thus the beginning of what came to be known as the Family
Movement. In the early days of family systems development, most of the psychiatrists utilized
the psychoanalytic theory as the approach to treatment. Since the basic concepts of
psychoanalytic treatment were not in keeping with seeing more than one person in a given
session, the family therapy movement was so called “underground”. The family treatment
modality did not gain much acceptance until the 1960’s.

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In 1954, Dr. Murray Bowen embarked on a research project with the National Institute of
Mental Health. The purpose of the project was to study the dynamics of schizophrenia. He
devised the research in such a manner that he began studying the mother-child relationship. He
soon learned that the process involved not only the mother and child, but the entire family.
While studying families who lived on the research unit, he also studied families with less
debilitating problems and even families who were so called “normal”. What he observed
occurring in the families who had a schizophrenic member in an intense degree he also observed
occurring to some degree in all families. Thus he began to think in a new way about emotional
illness.

Six years after his research began; Bowen published the first concepts of family systems theory.
He has continued to add concepts through the years and in November of 1975 officially labeled
his work as Bowen Theory. Today the theory has evolved to include concepts applicable to
families, to work systems, and to the larger social systems.
Bowen believed that human behavior is linked to biological functioning; therefore, he studied
diligently the biological sciences as he developed the theory. The terms used as concepts are in
keeping with terms utilized in the biological sciences. He always encouraged those who
learned Bowen Theory to search for the connection between the theory and the biological
sciences.

There are two main variables in the Bowen Theory: degree of anxiety and degree of integration
of self. According to Bowen, all organisms are reasonably adaptable to acute anxiety. When
anxiety is chronic, the organism develops tension, either within the organism or in the
relationship system. The tension produced by enduring anxiety precipitates symptoms,
dysfunction or sickness. The symptoms are manifested by physical illness, by emotional
dysfunction, social illness characterized by impulsiveness, withdrawal or social misbehavior in a
spouse; or by emotional or behavioral dysfunction in a child.

Key Figures of the Theory

Murray Bowen was born in 1913 in Tennessee and died in 1990. He trained as a psychiatrist and
originally practiced within the psychoanalytic model. At the Menninger Clinic in the late 1940s,
he had started to involve mothers in the investigation and treatment of schizophrenic patients.
His devotion to his own psychoanalytic training was set aside after his move to the National
Institute of Mental Health (NIMH) in 1954, as he began to shift from an individual focus to an
appreciation of the dimensions of families as systems.

At the National Institute of Mental Health (NIMH), Bowen began to include more family
members in his research and psychotherapy with schizophrenic patients. Bowen proceeded to
encourage students to work on triangles and intergenerational patterns in their own families of
origin rather than undertaking individual psychotherapy. From this generation of trainees have
come the current leaders of Bowenian Therapy, such as Michael Kerr at the Georgetown Family
Center, Philip Guerin at the Center for Family Learning, Betty Carter at the Family Institute of
Westchester, and Monica McGoldrick at the [Multicultural] Family Institute of New Jersey.

Key Concepts

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a) Differentiation of Self

The first concept is Differentiation of Self, or the ability to separate feelings and thoughts.
Undifferentiated people cannot separate feelings and thoughts; when asked to think, they are
flooded with feelings, and have difficulty thinking logically and basing their responses on that.
Further, they have difficulty separating their own from other's feelings; they look to family to
define how they think about issues, feel about people, and interpret their experiences.

Differentiation is the process of freeing yourself from your family's processes to define yourself.
This means being able to have different opinions and values than your family members, but
being able to stay emotionally connected to them. It means being able to calmly reflect on a
conflicted interaction afterward, realizing your own role in it, and then choosing a different
response for the future.

b) Triangles

Triangles are the basic units of systems. Dyads are inherently unstable, as two people will
vacillate between closeness and distance. When distressed or feeling intense emotions, they will
seek a third person to triangulate. Think about a couple who has an argument, and afterward, one
of the partners calls their parent or best friend to talk about the fight. The third person helps them
reduce their anxiety and take action, or calm their strong emotions and reflect, or bolster their
beliefs and make a decision. People who are more undifferentiated are likely to triangulate others
and be triangulated. People who are differentiated cope well with life and relationship stress, and
thus are less likely to triangulate others or be triangulated. Think of the person who can listen to
the best friend's relationship problems without telling the friend what to do or only validating the
friend's view. Instead, the differentiated person can tell the best friend "You know, you can be
intimidating at those times..." or "I agree with you but you won't change your partner; you either
have to learn to accept this about them, or have to call this relationship quits..."

c) The Nuclear Family Emotional Processes

These are the emotional patterns in a family that continue over the generations. Think about a
mother who lived through The Great Depression, and taught her daughter to always prepare for
the worst case scenario and be happy simply if things are not that bad. The daughter thinks her
mother is wise, and so adopts this way of thinking. She grows up, has a son, and without
realizing it, models this way of thinking. He may follow or reject it, and whether he has a happy
or distressed relationship may depend on the kind of partner he finds. Likewise, think of a
daughter who goes to work for her father, who built his own father's small struggling business
into a thriving company. He is seen in the family as a great businessperson as he did this by
taking risks in a time of great economic opportunity. He teaches his daughter to take risks,
"spend money to make money," and assume a great idea will always be profitable. His daughter
may follow or reject her father's advice, and her success will depend on whether she faces an
economic boom or recession.

In both cases, the parent passes on an emotional view of the world (the emotional process),
which is taught each generation from parent to child, the smallest possible "unit" of family (the

22
nuclear unit). Reactions to this process can range from open conflict, to physical or emotional
problems in one family member, to reactive distancing (see below). Problems with family
members may include things like substance abuse, irresponsibility, depression....

d) The Family Projection Process

This is an extension of The Nuclear Family Emotional Process in many ways. The family
member who "has" the "problem" is triangulated and serves to stabilize a dyad in the family.
Thus, the son who rejects his mother's pessimistic view may find his mother and sister become
closer, as they agree that he is immature and irresponsible. The more they share this view with
him, the more it makes him feel excluded and shapes how he sees himself. He may act in accord
with this view and behave more and more irresponsibly. He may reject it, constantly trying to
"prove" himself to be mature and responsible, but failing to gain his family's approval because
they do not attribute his successes to his own abilities ("He was so lucky that his company had a
job opening when he applied..." or "It's a good thing the loan officer felt sorry for him because he
couldn't have managed it without that loan..."). He might turn to substance abuse as he becomes
more and more irresponsible, or as he struggles with never meeting his family's expectations.
Similarly, the daughter who faces harsh economic times and is more fiscally conservative than
her father is seen by the parents as too rigid and dull. They join together to worry that she'll
never be happily married. She might accept this role and become a workaholic who has only
superficial relationships, or reject it and take wild risks that fail. In the end, she may become
depressed as she works more and more, or as she fails to live up to her father's reputation as a
creative and successful business person.

The family member who serves as the "screen" upon which the family "projects" this story will
have great trouble differentiating. It will be hard for the son or daughter above to hold their own
opinions and values, maintain their emotional strength, and make their own choices freely
despite the family's view of them.

e) The Multigenerational Transmission Process

This process entails the way family emotional processes are transferred and maintained over the
generations. This captures how the whole family joins in The Family Projection Process, for
example, by reinforcing the beliefs of the family. As the family continues this pattern over
generations, the also refer back to previous generations ("He's just like his Uncle Albert - he was
always irresponsible too" or "She's just like your cousin Jenny - she was divorced four times.").

f) Sibling Position

Bowen stressed sibling order, believing that each child had a place in the family hierarchy, and
thus was more or less likely to fit some projections. The oldest sibling was more likely to be seen
as overly responsible and mature, and the youngest as overly irresponsible and immature for
example. Think of the oldest sibling who grows up and partners with a person who was also an
oldest sibling. They may be drawn to each other because both believe the other is mature and
responsible. Alternately, an oldest sibling might have a relationship with someone who was a
youngest sibling. When one partner behaves a certain way, the other might think "This is exactly
how my older/younger sibling used to act."

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g) Emotional Cut off

This refers to an extreme response to The Family Projection Process. This entails a complete or
almost-complete separation from the family. The person will have little, if any, contact, and may
look and feel completely independent from the family. However, people who cut off their family
are more likely to repeat the emotional and behavioral patterns they were taught. In some cases,
they model the same values and coping patterns in their adult family that they were taught in
their childhood family without realizing it. They do not have another internal model for how
families live, and so it is very hard to "do something different." Thus, some parents from
emotionally constrained families may resent how they were raised, but they do not know how to
be "emotionally free" and raise a family as they believe other families would. In other cases, they
consciously attempt to be very different as parents and partners; however, they fail to realize the
adaptive characteristics of their family and role models, as well as the compensatory roles played
in a complex family. Thus, some parents from emotionally constrained childhood families might
discover ways to be "emotionally unrestrained" in their adult families, but may not recognize
some of the problems associated with being so emotionally unrestrained, or the benefits of being
emotionally constrained in some cases. Because of this, Bowen believed that people tend to seek
out partners who are at about the same level of individuation.

Societal Emotional Processes

These processes are social expectations about racial and class groups, the behaviors for each
gender, the nature of sexual orientation... and their effect on the family. In many ways, this is
like The Family Projection Process scaled up to the level of a society as a whole. Families that
deal with prejudice, discrimination, and persecution must pass on to their children the ways they
learned to survive these factors. The coping practices of the parents and extended family may
lead to more or less adaptive emotional health for the family and its members.

Therapeutic Goals/Therapists Function

a) Reframing the presenting problem as a multigenerational problem that is caused by

factors beyond the individual
b) Lowering anxiety and the "emotional turmoil" that floods the family so they can reflect
and act more calmly
c) Increasing differentiation, especially of the adult couple, so as to increase their ability to
manage their own anxiety, transition more effectively to parenthood, and thus fortify the
entire family unit's emotional wellbeing
d) Using the therapist as part of a "healthy triangle" where the therapist teaches the couple to
manage their own anxiety, distance, and closeness in healthy ways
e) Forming relationships with the family member with "the problem" to help them separate
from the family and resist unhealthy triangulation and emotional fusion
f) Opening closed ties with cut off members
g) Focusing on more than "the problem" and including the overall health and happiness of
the family

24
 h) Evaluating progress of the family in terms of how they function now, as well as how
adaptive they can be to future changes
i) Addressing the power differential in heterosexual couple based on differences, for
example, in economic power and gender role socialization (this is a contribution of those
who have reconsidered bowen's theory through a feminist lens)

In general, the therapist accomplishes this by giving less attention to specific problem they
present with, and more attention to family patterns of emotions and relationships, as well as
family structures of dyads and triangles. More specifically, the therapist

Techniques and Practice of the Theory

a) Genogram: Bowen used what he termed as “family diagram” to collect and organize
important data concerning the multigenerational family system. The main function of the
genogram is to organize data during the evaluation phase and to track relationship
processes and key triangles over the course of therapy.

b) Therapy triangle: This technique ensures that the therapist remains neutral, that is free
of emotional reactivity thus calming the family members so that they can work out
solutions to their dilemmas. Additionally, the therapist works to de-triangulate the
symptomatic person in the family.
c) Relationship experiments: The goal is to help family members become aware of the
systems processes and their role in it. Pursuers are encouraged to refrain pursuit, stop
making demands and decrease pressure for connection and see what happens to
themselves and the relationship. Distancers are encouraged to move towards the other
person and communicate personal thoughts and feelings; in other words stop avoiding or
reacting to the other person’s demands.
d) Coaching: Coaching is the Bowenian alternative to the more emotionally involved role
common to most other forms of therapy. Coaching doesn’t mean telling people what to
do. It means asking process questions designed to help clients figure out emotional
processes and their role in them. The goal is increased understanding, increased self-
focus, and more functional attachments to key family members.

25
 e) The ‘I’ position: Helping family members take a personal stance-saying what you feel
instead of what others are doing-it is one of the ways of breaking emotional reactivity.
Clients reframe their blaming and apportioning feelings, thoughts and actions to others.
Instead of saying, “you are lazy” a member can say, “I wish you would help me more.”
Bowenian therapists not only encourage clients to take I- positions, they also do so
themselves.
f) Multiple family therapy: Bowen worked with couples, taking turns focusing on the first
one, then another, and minimizing interaction. The idea is that one couple may learn
more about emotional process by observing others-others in whom they are not so
invested as to have their vision clouded by feelings.
g) Displacement stories: It is about showing films and video tapes and stories to teach
family members about systems functioning in a way that minimizes their defensiveness.

Conditions for Change

Increasing the ability to distinguish between thinking and feeling and learning to use that ability
to resolve relationship problems is the guiding principle of Bowenian therapy. Lowering anxiety
and increasing self-focus –the ability to see one’s role in interpersonal processes-is the primary
mechanism of change. Understanding, not action is the vehicle of cure hence therapists ask
questions to foster self-reflection. Individuals are encouraged to look to their roles in the process.

Bowen believed meaningful change does not require the presence of an entire family. Instead, he
believed that change is initiated by individuals or couples who are capable of affecting the rest of
the family. Therapy can be described as proceeding from inside out. Differentiation of self,
which begins as a personal and individual process, is the vehicle for transforming relationships-
and the entire family system. Part of the process of differentiating a self is to develop a personal
relationship with everyone in the extended family. Increasing the number of important
relationships will enable an individual to spread out his/her emotional energy.

Equally, Bowenian therapists strive to control their own reactivity and to avoid triangulation.
Therapy with couples is based on the premise that tension in the dyad will dissipate if they
remain in contact with a third person (in a stable triangle)-if that person remains neutral and
objective rather than emotionally entangled. Thus a therapeutic triangle can reverse the insidious
process of problem maintaining triangulation. Bowenians teach individuals about triangles and
then coach them to return to their families, where they work to de-triangle themselves, develop
greater objectivity and thus achieve a permanent reduction in emotional reactiveness.

32.3.05 EXPERIENTIAL FAMILY THERAPY/SYMBOLIC EXPERIENTIAL

APPROACH

Historical Development of the Theory

Experiential branch of family therapy emerged from humanistic wing of psychology which
emphasized immediate here and now experience. Experiential therapy was popular when family
therapy was young, when therapists talked about systems but borrowed their techniques from
individual and group therapies. From Gestalt therapy and encounter groups came evocative

26
techniques such as role playing and emotional confrontation, while other expressive methods such
as sculpting and family drawing bore the influence of the arts and psychodrama.

Experiential family therapists share the humanistic belief that people are naturally resourceful and
if left to their own devices will be energetic, creative, loving and productive. The task of therapy is
therefore seen as unblocking defenses and releasing innate vitality.

In focusing on emotional experience than on the dynamics of interaction, experiential therapists

seemed to be out of step with the rest of family therapy. Indeed by emphasizing individuals and
their feelings, experiential treatment may never have been well suited to family therapy as were
approaches that dealt with systems and action. Recently however, experiential approaches have
been enjoying a revival like Greenberg and Johnson’s (1985) emotionally focused couples therapy
and Schwartz’s (1995) internal family systems model have combined the emotional impact of an
experiential focus on the individual with a more sophisticated understanding of family systems.
Sigmund Freud discovered that getting in touch with painful feelings is not, by itself a sufficient
model of psychotherapy. On the other hand, ignoring or rationalizing unhappy emotions may cheat
clients out of the opportunity to get to the heart of the problems. Thus the experiential emphasis on
emotional expression continues to be a useful counterweight to the reductionist emphasis on
behavior and cognition common to today’s problem solving approaches.

Key Figures of the Theory

Two giants stand out in the development of experimental therapy which was in the tradition of
humanistic approaches: Carl Whitaker and Virginia Satir. Virginia Satir will be discussed when
expounding on Human Validation theory (an experiential approach) (in section 32.3.08 of this
manual) which she developed.

Carl Whitaker was a 20th century psychiatrist, educator, and family therapist who helped found
the field of experiential family therapy, sometimes referred to as the symbolic-experiential
approach to therapy. He was born in Raymondville, New York in 1912. Whitaker received his
MD in gynecology and obstetrics, before returning to school in 1938 to study psychology at
Syracuse University. At the Syracuse Psychopathic Hospital, he worked with schizophrenic
patients, whom he found fascinating. In many cases, Whitaker observed that the patients’
symptoms would disappear for a period, only to reappear when they were sent back home. This
revelation led Whitaker to begin exploring a family therapy approach, rather than just treating
the person.

He chaired the Department of Psychiatry at Emory University from 1946 to 1955, where he
continued to work with schizophrenic clients and their families to design new and innovative
approaches to treatment in family therapy. In 1955, he founded the Atlanta Psychiatric Clinic,
where he further refined his family therapy techniques. Whitaker returned to academia in 1965,
when he took a position in the psychiatry department of the University of Wisconsin in Madison.
He remained there until his retirement in 1982.

He is most well-known for acknowledging the role of the entire family in the therapeutic process.
He is the founder of experiential family therapy, or the symbolic-experiential approach to

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therapy. Rather than scapegoating one family member or even a specific family problem,
experiential family therapy looks at the entire family system. Several other approaches to family
therapy have drawn heavily from Whitaker's theories.

Whitaker’s humanistic approach focused on getting at the heart of the feelings experienced by all
members of a family. He aimed to stir things up in therapy sessions and allow family members to
express themselves more fully. Whitaker often called his work absurd as he used unconventional
strategies, such as humor, play, and directness to try to draw out and expose family members.
Confrontation is common in experiential family therapy, but it is tempered with encouragement,
support, and guidance from the therapist. Whitaker’s views are outlined in The Family Crucible,
written in collaboration with August Napier and published in 1978. His last book on the subject,
Midnight Musings of a Family Therapist, was published in 1988.

Whitaker also developed a practice called co-therapy, in which a pair of therapists work together
to serve clients. Whitaker first employed this method while providing back-to-back intensive,
brief sessions during World War II, and he continued to use it throughout his career.

Key Concepts

a) Psychopathology as Distraction

Whitaker saw “symptoms as mere signals of, or even noisome distractions from, the real
existential problems faced by families—birth, growing up, separation, marriage, illness, and
death.”

Whitaker contended: “Psychopathology is proof of psychological health. The individual who is

distorted in his thinking is essentially carrying on an open war in himself rather than capitulating
to the social slavery. His delusion system and his hallucinations are a direct result of this war
with his lifetime situation—the stresses of his living and his efforts to defeat those stress rather
than become a non-person and a social robot.”

b) Responsibility of People in Therapy

Whitaker’s emphasis on personal freedom and responsibility derived from philosophers, such as
Martin Heidegger and Edmund Husserl, who considered the psychological implications of
existentialist thought. Ludwig Binswanger (1967) assimilated these ideas into psychotherapeutic
formulation, emphasizing “freedom and the necessity to discover the essence of one’s
individuality in the immediacy of experience.”

Throughout Whitaker’s writings and therapeutic example, he conveyed existentialist

presuppositions: anxiety and suffering can be growth inducing; people have power to choose to
be responsible; elements of the human condition which exist in clients’ relationships with each
other exist between clients and therapists. Rousing awareness of change processes, Whitaker
coaxed people toward ownership. He declared, “The integrity of the family must be respected.
They must write their own destiny”

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c) Value of Courage

Whitaker regarded existential anxiety as an “irresolvable dialectic,” contending: “The effort to

solve living as a problem is impossible. … The process of facing the dialectic life … is endless,
irresolvable, and poorly understood. … Security alone equals slavery. Exploration alone equals
danger and death. The flux is always exciting but never an answer, only a courage-inducing
impetus to more of the individual’s right to decide on the next move and to discover more and
dare more.

d) Transformative Nature of Vulnerable Encounter

By daring to be vulnerable with people in therapy, Whitaker exposed families to an existential

encounter. When the family comes “face to face with part of your insides, they have to decide
what to do. … They’re free to produce their own extrapolations, depending on how it
reverberates inside of them.”

The concept of the “I-thou” relationship stems from the writings of Buber (1937), who
philosophized that the nature of our interactions with others are often more “I-it” than “I-thou.”

One of Whitaker’s common therapeutic goals was for family members to begin to experience
themselves more openly and nondefensively with one another; that an existential shift occur on a
systemic level.

e) Primacy of Affective Experiencing

During one session, Napier and Whitaker (1978) hypothesized, “They [are] most afraid of what
many couples find the threatening aspect of their marriages: deadness.” Keith and Whitaker
(1982) wrote, “We presume it is experience, not education that changes families.”

Whitaker often redirected attentions from the content of conflict to the emotional process: “I
would guess that almost anything you focused on together would bring out this disagreement.
… It feels more like a fear of conflict that’s the problem, rather than some particular issue you
are fighting over” (Napier and Whitaker, 1978).

f) Power of Artful Communication

Whitaker developed the notion of symbolic communication as interactional metaphor based

largely on George Herbert Mead’s concept of symbolic interactionism. Whitaker stressed the
importance creating and shaping meaning between people and, consequently, facilitating shifts
within the family emotional system. Whitaker saw his role as engaging a family by raising the
intensity within its relationships and communicating symbolic meaning through experiential
interaction in such a way as to catalyze the family toward intimacy.

g) Spontaneous Evocation as Healthy

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Whitaker advocated a spontaneous and evocative presence with people in therapy as a means of
engaging them at the hidden symbolic dimensions of awareness. Perhaps his most well-known
display of spontaneity in therapy was when he wrestled with a teenage boy who had knocked
Carl’s glasses off in a moment of rage: “As Don had struck out in panic and anger at Carl, Carl
had tackled him, and the two of them went down onto the Oriental carpet, a tangle of limbs”
(Napier & Whitaker, 1978). This unplanned and, arguably, unprofessional encounter was
certainly one of Whitaker’s more radical therapeutic moments. Yet it was also indicative of
Whitaker’s view of therapy. Whitaker went as far as to advocate “craziness”—nonrational, right-
brain experiencing—as a measure of health in both therapist and family (Whitaker &Keith,
1981). Whitaker explained, “My craziness [has given] other people the freedom to be more
spontaneous, to be more intuitive, to be crazy in their own ways.”

h) Necessity of Present-Centeredness

Whitaker was careful to observe and allow himself to react quickly and intuitively to interactions
between family members, both to prevent unhelpful more-of-the-same dynamics and to highlight
potential signals of underlying emotional patterns, often the very mire in which the family is
stuck. Whitaker saw the problems that families brought to therapy as failures to adapt together to
common problems of life and the here-and-now as the necessary moment for creative
intervention and change. He urged, “Life isn’t mind over matter, it’s present over past and
present over future” (Keith & Whitaker, 1982).

i) Developmental Growth as Necessarily Relational

Every person must counterbalance needs for individual autonomy with needs for relational
connection. Whitaker believed that therapy must stimulate the growth of the person alongside the
growth of the system. Whitaker worked to facilitate family cohesion, ensure family members
were meeting each other’s needs in the process of their own individuation, and were developing
increasing proclivities for spontaneity, creativity, and attunement within the family unit. For
Whitaker, the individual cannot grow in a relational vacuum.

j) Need for Holistic Versus Reductionist Goals

Whitaker saw the trajectory of therapy moving toward, for example, a heightened sense of
competence, well-being, the development of compassion, self-esteem, role flexibility, awareness,
self-responsibility, greater sensitivity, learning to recognize and express emotions, achieving
intimacy with a partner, and so on.

Therapeutic Goals/Therapists Function

a) In experiential family therapy, symptom relief is secondary to increased personal integrity
and expanded experiencing. Experientialists emphasize on the feeling side of human
nature: creativity, spontaneity and ability to play-and in therapy, the value of experience
for its own sake. Most experiential therapists focus on individuals and their experience
more than on family organization.

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 b) Personal growth requires family integration for belongingness and individuation goes hand
in hand. New experience of family members is thought to break down rigid expectancies
and unblock awareness-all of which promotes individuation.
c) Heightened sense of competence, wellbeing and self-esteem. Family members according to
Whitaker come to counselling because they are unable to be close and therefore
individuate. By helping family members recover their own potential for experiencing. He
believed that he was also helping them recover their ability to care for one another.

Techniques and Practice of the Theory

a) Self as a therapeutic tool

In experiential therapy, there no common techniques; it is not so much of what therapists
do but who they are. To foster openness in clients’ therapists they must be open.
However, experiential therapists tend to do a lot; they are highly active and use quite
number evocative techniques.

b) Family sculpting
Family sculpting provides for recreation of the family system, representing family
members relationships to one another at a specific period of time. The family therapist can
use sculpting at any time in therapy by asking family members to physically arrange the
family. Adolescents often make good family sculptors as they are provided with a chance
to nonverbally communicate thoughts and feelings about the family. Family sculpting is a
sound diagnostic tool and provides the opportunity for future therapeutic interventions.

c) Tracking
Most family therapists use tracking. Tracking is an essential part of the therapist's
joining process with the family. During the tracking process the therapist listens intently
to family stories and carefully records events and their sequence. Through tracking, the
family therapist is able to identify the sequence of events operating in a system to keep it
the way it is. What happens between point A and point B or C to create D can be helpful
when designing interventions.
d) Communication Skill-building
Communication patterns and processes are often major factors in preventing healthy
family functioning. Faulty communication methods and systems are readily observed
within one or two family sessions. A variety of techniques can be implemented to focus
directly on communication skill building between a couple or between family members.
Listening techniques including restatement of content, reflection of feelings, taking turns
expressing feelings, and nonjudgmental brainstorming are some of the methods utilized
in communication skill building. In some instances the therapist may attempt to teach a
couple how to fight fair, to listen, or may instruct other family members how to express

31
 themselves with adults. The family therapist constantly looks for faulty communication
patterns that can disrupt the system.
d) Family Photos
The family photos technique has the potential to provide a wealth of information about
past and present functioning. One use of family photos is to go through the family album
together. Verbal and nonverbal responses to pictures and events are often quite
revealing. Adaptations of this method include asking members to bring in significant
family photos and discuss reasons for bringing them, and locating pictures that represent
past generations. Through discussion of photos, the therapist often more clearly sees
family relationships, rituals, structure, roles, and communication patterns
e) Family Floor Plan
The family floor plan technique has several variations. Parents might be asked to draw
the family floor plan for the family of origin. Information across generations is therefore
gathered in a nonthreatening manner. Points of discussion bring out meaningful issues
related to one's past. Another adaptation of this technique is to have members draw the
floor plan for their nuclear family. The importance of space and territory is often
inferred as a result of the family floor plan. Levels of comfort between family members,
space accommodations, and rules are often revealed. Indications of differentiation,
operating family triangles, and subsystems often become evident. Used early in therapy,
this technique can serve as an excellent diagnostic tool

f) Reframing
Most family therapists use reframing as a method to both join with the family and offer a
different perspective on presenting problems. Specifically, reframing involves taking
something out of its logical class and placing it in another category. For example, a
mother's repeated questioning of her daughter's behavior after a date can be seen as
genuine caring and concern rather than that of a non-trusting parent. Through reframing,
a negative often can be reframed into a positive.

Conditions for Change

Families are not fragile hence effective treatment requires powerful interventions and that power
comes from emotional experiencing. Experiential clinicians use evocative techniques and the
force of their own personalities to create therapeutic encounters. The vigor of the therapist as a
person is a major force in therapy: the vigor of the encounter is the other. To help the clients take
risks, experiential therapists are alternatively provocative and warmly accepting. This permits
family members to drop the defenses and open up to each other. The therapist must be a genuine
person who catalyzes change using his/her personal impact on families.

Experiential therapists believe that increasing the experience levels of individual family
members will lead to more honest and intimate family interactions. Families will accept a great
deal from a therapist, once they are convinced that he/she genuinely cares about them. While
experiential family therapists emphasize expanded experiencing for individuals as vehicle for

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therapeutic change, they are now beginning to advocate inclusion of as many members as
possible in treatment. Inviting the extended family members is an effective way to help them
support treatment, instead of opposing or undermining it. In order to overcome reluctance to
attend, Whitaker invited extended family members as consultants, “to help the therapist” not as
patients. By participating in therapy they felt valued by the inclusion.

Bibliography

a) Binswanger, L. 1967. Being-in-the-world. In Selected papers of Ludwig Binswanger, J.

Needleman, ed. New York: HarperTorchbooks
b) Buber, M. (1937). I and Thou (2nd), translated by Ronald Gregor Smith. Edinburgh: T.
and T. Clark.
c) Greenberg, L.S. and Johnson, S.M. 1985. Emotionally focused couple therapy: an
effective systemic approach. In Handbook of Marital and Family Therapy, N.S. Jacobson
and A.S. Gurman, eds. NewYork: Guilford Press
d) Keith, D. V., and Whitaker, C. A. (1982). Experiential-symbolic family therapy. In A. M.
Horne and M. M. Ohlsen (Eds.), Family counseling and therapy. Itasca, IL: Peacock.
e) Napier, A. Y., and Whitaker, C. A. (1978). The family crucible. New York: Harper &
Row.
f) Schwartz, R.C. 1995. Internal family systems therapy. New York: Guilford Press
g) Whitaker, C. A., and Keith, D. V. (1981). Symbolic-experiential family therapy. In A. S.
Gurman and D. P. Kniskern (Eds.), Handbook of family therapy. New York:
Brunner/Mazel.

32.3.06 HUMANISTIC FAMIY APPROACH

Historical Development of the Theory

Humanistic psychology rose to prominence in the mid-20th century in response to the limitations
of Sigmund Freud's psychoanalytic theory and B. F. Skinner's behaviorism. With its roots
running from Socrates through the Renaissance, this approach emphasizes individuals' inherent
drive towards self-actualization, the process of realizing and expressing one's own capabilities,
and creativity.

Among the earliest approaches are the developmental theory of Abraham Maslow, which
emphasizes a hierarchy of needs and motivations, and the client-centered therapy of Carl Rogers,
which is centered on the client's capacity for self-direction and understanding of his or her own
development. The term "actualizing tendency" was also coined by Rogers and was a concept that
eventually led Maslow to study self-actualization as one of the needs of humans. Rogers and
Maslow introduced this positive, humanistic psychology in response to what they viewed as the
overly pessimistic view of psychoanalysis; during the 20th century, humanistic psychology
became known as the "third force" in psychology.

Key Figures of the Theory

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The humanistic, experiential, or “third force” of psychology and psychotherapy arose primarily
in reaction to the way the second force, behaviorism, completely disregarded the inner
experience of individuals and focused only on easily quantifiable behaviors.

Rogers and Maslow introduced this positive, humanistic psychology in response to what they
viewed as the overly pessimistic view of psychoanalysis. In the late 1930s, psychologists,
interested in the uniquely human issues, such as the self, self-actualization, health, hope, love,
creativity, nature, being, becoming, individuality, and meaning—that is, a concrete
understanding of human existence, included Abraham Maslow, Carl Rogers, and Clark
Moustakas, who were interested in founding a professional association dedicated to a psychology
focused on these features of human capital demanded by post-industrial society.

Virginia Satir and Carl Whitaker developed the existential family therapy that focused on the
person of the therapist and family as a growing organism. The way that all of the various
humanistic therapies were “experiential” was in the belief that therapeutic change occurs in the
honest and accurate self-expression of the experience of both the therapist and client, in the here-
and-now of the session, in the context of their genuine, empathic, therapeutic relationship.

Key Concepts

Basic principles: The five basic principles of humanistic psychology are:

a) Human beings, as human, supersede the sum of their parts. They cannot be reduced to
components.
b) Human beings have their existence in a uniquely human context, as well as in a cosmic
ecology.
c) Human beings are aware and are aware of being aware - i.e., they are conscious. Human
consciousness always includes an awareness of oneself in the context of other people.
d) Human beings have the ability to make choices and therefore have responsibility.
e) Human beings are intentional, aim at goals, are aware that they cause future events, and
seek meaning, value, and creativity.

Asks, “what?” and here-and-now focus: Traditionally, the important question to answer was
“why?” Insight into causality was considered the most powerful tool for therapeutic change. In
family systems theory, the focus shifted to “what?” This was ostensibly because “why?” was
unknowable, but in practice, “why” was assumed — the family system is failing to adapt — so
“what?” became the pertinent question; seeing the way in which the problem perpetuated itself –
in the present, in the room with the therapist – was now the most powerful tool. Experiential
therapists concur with this, both because of their systemic understanding that problems are
maintained by the behavior of the family system, and because of their humanistic focus on the
quality of experience in the moment.

Reciprocal causality and patterns: Family systems thinkers believe that traditional thinkers see
linear causality in the world because of a mistake in punctuating events. The classic example is
the husband who withdraws “because” his wife nags. Instead of punctuating before the wife
nags and after the husband withdraws, a systems thinker sees a reciprocally-causal pattern of

34
events, in which the husband and wife are participating in an interactive pattern of nagging and
withdrawing. Experiential therapists introduce a kind of blame-free personal responsibility for
one’s emotional states and behaviors with the exception of symptomatic behavior in children,
which is seen as a somewhat unidirectional result of communication problems of the parents.

Wholistic: While traditional thinkers are reductionistic, seeing problems in individuals or even
the psychodynamic or biological parts of individuals, family systems thinkers prefer to see
problems in the context of the “whole” family system. Experiential family therapists may be
more rigorous about this than those of most other models. Whitaker, for example, would often
refuse to see clients without their families, and preferred to have three generations come in.
Experiential therapists’ inclusion of emotion as an important aspect of therapy can also be seen
as more “wholistic” than some other family therapists, who focus only on behavior and
cognition.

Subjective/perceptual: One of the great overestimations of traditional science was the belief that
humans could be objective in their gathering knowledge. This misconception was set straight by
postmodern philosophers such as Von Glasersfeld (1984), rather than systems theorists; an
individual’s understanding is limited and colored at every step of the process, from perception to
description, by factors of which they are not aware. Experiential therapists align with the
postmodernists here, focusing on and trying to communicate – as authentically (as opposed to
objectively) as possible – their own subjective experiences, rather than on “knowing” or the
illusion of observing from the outside.

Relational and contextual: Traditionally, problems were seen as pathology in an individual, or

in a psychodynamic or biological part of an individual, but family systems theory came to see
problems as existing in relational patterns, in communicative behavior and in the individual’s
social context, usually the family. This tenet is strongly upheld by experiential therapists too; if
individuals are naturally good and healthy in humanistic psychology, it has to be the context they
exist in that produces symptomatic or problem behavior.

Relativistic and dialectical: Modern science overcame the absolutism of the premodern era to a
great degree, but a vestige remained in the form of a belief in the reality of the conceptual
categories “discovered” by scientists, and in the implied truth of theories which had gathered
some supportive evidence. Postmodernism came to see all opinions and ideas as part of a dialog
between different perspectives, and thus not related to each other in hierarchical fashion – true
versus false, or even more informed versus less informed – but existing side by side, equally
valid. Experiential therapists follow this new tradition, giving equal weight to the experiences of
all family members as well as the therapist. Experiential family therapy, while directed by the
therapist, can look very much like a conversation in which the therapist and family members
come to understand each other’s values and experiences.

Proactive: Family systems therapists tend to be proactive in comparison to the psychoanalytic

school. That is, where in psychoanalysis the therapist and client would sit together regularly for
years, talking about the client’s history and aiming at a restructuring of the client’s
psychodynamics through intellectual insight, family systems therapists tend to do their work
briefly, in 8-10 sessions, focusing on the client’s presenting problem with relative directness.

35
Experiential therapists are proactive compared to psychoanalysis, in that they work more briefly
and use direct emotional interventions such as Satir’s family sculpting or Whitaker’s emotional
confrontation. They use straightforward coaching and reframing to cause the emotional and
communication shifts they believe are called for. On the other hand, they may appear less
proactive than some other family therapy models which focus more directly on changing a
single, problematic behavior.

Therapeutic Goals/Therapists Function

a) Humanistic therapy helps the family to develop a stronger, healthier sense of identity
b) Individuals in the family are helped to understand their feelings to help gain a sense of
meaning in life. Humanistic theory sees each individual's personality as being composed
of physical, intellectual, emotional, behavioral, creative, and spiritual elements.
c) Families in therapy are assisted to attain self-actualization and start performing at their
optimum levels
d) Humanistic therapy focuses on the individual's strengths and offers non-judgmental
counseling sessions.

Techniques and Practice of the Theory

Empathic understanding of the client's frame of reference and subjective experience

Respect for the client's cultural values and freedom to exercise choice

Exploration of problems through an authentic and collaborative approach to helping the client
develop insight, courage, and responsibility

Exploration of goals and expectations, including articulation of what the client wants to
accomplish and hopes to gain from treatment

Clarification of the helping role by defining the therapist's role but respecting the self
determination of the client

Assessment and enhancement of client motivation both collaboratively and authentically

Negotiation of a contract by formally or informally asking, "Where do we go from here?"

Demonstration of authenticity by setting a tone of genuine, authentic encounter

Conditions for Change

The core assumptions of experiential family therapists are essentially the core assumptions of
humanistic psychology, adapted to a family systems epistemology: Unless held back by their
environment, individual humans tend towards and self-actualization and can reach their
potential. The environment is primarily the system of relationships and communication that

36
individual exists in. It can stunt an individual’s growth by teaching them that it is not safe to
fully feel or express the experience they are having, especially in the moment they are having it.
This serves to keep individuals from understanding themselves and others as they are, and from
experiencing real intimacy with others, and through that, from being able to experience their own
true individuality. The remedy for this is genuine, uncensored experience, communicated
accurately and authentically in intimate relationships, including the relationship with the
therapist. The therapist’s role is to model this kind of psychological congruence and intimacy
while coaching family members to follow suit in their own unique way. This will allow both the
individuals and their system to mutually support growth to the highest levels.

Experiential family therapists reflect all of the Common Factors in their process. They assume
that it is the unique expression of the client’s strengths that is the engine for their personal
growth. They emphasize that it is the ability of the therapist to model genuine expression of their
own unique strengths and to form intimate, genuine connections with the clients that is the
catalyst for change. Their belief in and respect for human beings should be a good vehicle for
encouraging hope for change in clients. Experiential therapists offer behavioral and affective
coaching as well as cognitive reframing as techniques to enhance the intimacy of relationships
and accuracy of perception and expression. They view problems as residing in family systems as
opposed to in individual psyches. They intervene primarily at the level of relationships and
systems and form intimate relationships with each person in the system.

There is considerable evidence that the bulk of therapeutic change can be attributed to (a) the
qualities and resources of clients, such as their resiliency, motivation, or community, (b) the
qualities and skills of the individual therapists, (c) the quality of the therapeutic relationship,
including the compatibility of the client and therapist’s objectives, (d) the client’s hope or
expectancy of change, and (e) other factors such as behavioral, cognitive, and affective coaching.
Additionally, Sprenkle and Blow assert that family therapy has three Common Factors that
individual therapy does not: a view of problems in the context of social systems, intervention at
the level of systems, and multiple, simultaneous therapeutic relationships (2004).

Bibliography
Sprenkle, D. H. & Blow, A. J. (2004). Common factors and our sacred models. Journal of
Marital and Family Therapy, 30(1) 113-129.
Von Glasersfeld, E. (1984). An introduction to radical constructivism. In P. Watzlawick (Ed.)
The invented reality (pp. 17-40). New York: Norton.

32.3.07 STRUCTURAL FAMILY THERAPY

Historical Development of the Theory

The structural school of family therapy has its roots in a residential institution for Ghetto boys in
New York. In the 1960s, Salvador Minuchin and his colleagues were working at the Withwyck
School for boys, serving a population primarily from New York’s inner city ghettos. They found
psychoanalytic long term, passive, growth –oriented, therapy to be extremely ineffective with
these children, whose issues were immediate and survival based. Minuchin and his associates
experimented with a more active approach to therapy in which they worked with the boys and

37
their families together. Born out of this work with low socio-economic status families, structural
family therapy, is an active, problem-solving approach to a dysfunctional family context

Although Minuchin’s work with psychosomatic families is well known; he has broadened his
theoretical base and has applied this approach to patients to verify socio-economic classes with a
variety of presenting problems. Structural family therapy generally is characterized by its
emphasis on hierarchical issues. Typical goals of therapy include correcting dysfunctional
hierarchies by putting parents in charge of their children and differentiating between subsystems
within families. Therapy usually involves changing the family structure by modifying the way
people relate to one another. This is done with a focus on the present, using direct, indirect and
paradoxically directives. Therapy is terminated when the family structure is positively altered
and is able to maintain itself without the use of the presenting problem

Key Figures of the Theory

Salvador who had studied Interpersonal Psychiatry and was born and raised in Argentina is the
main authority in Structural family therapy. Some of Minuchin’s colleagues are not as well known
among these are is Braulio Montalvo born in Puerto Rico who was committed in treating minority
families but favoured more gentler supportive approaches. The staff of leading teacher at the
Minuchin Center includes Ema Genijovich, Davi Greenan, George Simon and Wai-Yung Lee.
Among Minuchin’s other prominent students are Jorge Colapinto; Michael Nichols, Jay Lappin
and Charles Fishman.

Key Concepts
Boundaries
This are invisible lines of demarcation in a family, which may be defined, strengthened, loosened
or changed as a result of structural family therapy. Boundaries rage from “rigid” extreme
separateness to diffuse (extreme togetherness). Ideally boundaries are clear.

Coalition
It is an (usually covert) alliance between two family members against a third. When one parent
joins a child in a rigidly boundary cross-generational coalition against the other parent, this is
called a “stable condition”.

Detouring
It is a process whereby stresses between spouses get redirected through a child so that the spouse
subsystem gives the impression of harmony.

Disengaged Family
This is an extreme pattern of family organization where members are so separate they seem
oblivious to the effects of their actions on each other. Boundaries among family members are
typically rigid (Opposite of enmeshed family).

Enmeshed Family
An extreme pattern of family organization in which family members are so tightly locked that
autonomy is impossible. Boundaries among family members are typically diffuse (opposite of
disengaged family).

38
Family Mapping
It is the diagramming of a family’s organizational structure, boundaries and patterns of
interaction. Family mapping is useful in hypothesizing family functioning and formal goals for
structural changes.

Generational Boundaries
These are invisible lines of demarcation between generations. Healthy generational boundaries
allow parents to maintain parental roles and children to maintain child roles.

Parental Child
Role played by an overly responsible child who has power and authority that appropriately
belongs to the parents. This typically reflects an inappropriate generational boundary within the
family

Subsystems
These are units within a family based upon characteristics such as sex, age or interest, (e.g.
mother and daughter may represent the female subsystem in a family).

Triangulations
It is a process in which each parent demands that the child side with him/her against the other.
Parent siding with one is defined as attacking by the other, and the child feels paralyzed.

Therapeutic Goals/Therapists Function

a) Therapy is aimed at altering family structure so that the family can solve its problems.
Problem –solving is a by-product of this systematic goal.
b) To facilitate the growth of the system in order to resolve symptoms and encourage
growth in individuals, while also preserving the mutual support of family.
c) The creation of an effective hierarchical structure. Parents are expected to be in charge,
not to relate as equal to their children.
d) To help the parents to function together as a cohesive executive subsystem.
e) With enmeshed families, the goal is to differentiate individuals and subsystems by
strengthening the boundaries around them.
f) With disengaged families, the goal is to increase interaction by making boundaries more
permeable.

Techniques and Practice of the Theory

Accommodation
This is a general term referring to the adjustments a therapist may make to a family (e.g. joining,
maintenance) in order to achieve a therapeutic alliance with the family.

Boundary Making
This is a strategy in which the therapist reinforces appropriate boundaries and diffuses
inappropriate boundaries by modifying interactional patterns (e.g. a therapist may sit between an
intrusive mother and her child so that the mother will have difficulty speaking for the child).

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Creative a Workable Reality
A strategy, in which the therapist attends to certain family issues, ignores others and reframes
others to emphasize a family situation that has a solution.

Example: A presenting problem of childhood schizophrenia may be de-emphasized and the need
for parental cooperation and control in the family may be emphasized. Thus a “workable
reality” is created in which the parents have specific tasks to accomplish in relation to their
“misbehaving” child.
Enactment
The therapist encourages the acting out of dysfunctional transactional patterns within the family
therapy session. Through setting up these transactions in the present, the therapist is then to
intervene in the process by increasing its intensity, indicating alternative transactions, making
boundaries and so forth. The therapist may also have the family enact more positive
transactional patterns within the therapy session, which will serve as a template for more positive
interactions outside therapy.

Intensity
It refers to the degree of impact of a therapeutic message, selectively regulated by the therapist.
Intensity can be achieved by increasing the length of a transaction, or by frequently repeating the
same message in different transactions.

Intervening Isomorphically
The therapist focuses on events that are dissimilar in content, but nevertheless are structurally
equivalent. For example: whether an anorexic girl says she doesn’t know something, complains
about the clothes she wears or wont eat, the therapist can reframe such statements, as disrespect
for her parents authority.

Joining
It is an accommodating maneuver in which the therapist establishes rapport with family members
and temporarily becomes part of the family system. The family accepts the therapist more
openly, thus enhancing the therapist’s ability to bring about change.

Maintenance
An accommodating technique in which the therapist provides planned support of the family
structure while he/she analyses it. For example, comments like “I see, tell me more about …….”
and “uh-uh” are non –committal and gives the therapist the time to understand the family better.

Minesis
It is paralleling of a family’s mood or behavior, which solidifies a therapeutic alliance. For
example a therapist may talk slowly with a slow talking family and/ or be animated with an
animated family.

Restructuring

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It is any therapeutic intervention that confronts and challenges a family and facilitates structural
changes. Examples of restructuring maneuvers includes: Assigning tasks, shifting power system,
escalating stress, and marking boundaries.

Unbalancing
It is any therapeutic intervention that supports one member of the family, thus interfering with
the homeostasis of the family system.

Conditions for Change

For successful therapy to take place, the following is necessary:

Joining and Accommodating

Most family members will attend the sessions defensively and full of anxiety. The therapist
needs to disarm the family members their defenses and ease their anxiety. You do this by
conveying empathy and unconditional positive regard to every family member. Greet each
family member by name and make some kind of friendly contact. Failure to join and
accommodate produces tense resistance, which is often blamed on the family.
A useful beginning is to greet the family and then ask for each person’s view of the problems.

Working with Interaction

Family structure is manifest in the way family members interact. It cannot be inferred from their
descriptions or from reconstructing previous discussions. Family dynamics are what happen
when the family is in action not what they say happens, or what the therapist imagines must
happen. They have to talk among themselves for the dynamics to emerge. Structural family
therapists work with two sorts of interactions:
 Enactments and
 Spontaneous sequences
When the therapist gives any family member a chance to speak, he develops an enactment by
asking the family members to respond to each other. Once the enactment is begun the therapist
can discover many things about the family structure.
 How long can two people talk without being interrupted – that is how clear the boundary
is?
 Does one attack, and the other defends?
 Who is central, who is peripheral?
 Do parents bring children into their discussion? That is, are they enmeshed?
In adding to creating enactments, structural therapists also work with spontaneous sequences of
behavior. The first case (enactments), the therapist is like director telling the actors what to do. In
the second case (working with spontaneous sequences), the therapist is like a lighting expert,
focusing the spotlight of attention on some particular action. Families may demonstrate
enmeshment by frequently interrupting, speaking for other family members, doing things for
children that they can do for themselves, or by constantly arguing. In disengaged families, one
may see a husband sitting impassively while his wife cries, a total absence of conflict, a
surprising ignorance of important information about children and lack of concern for each
other’s interest. If as soon as the first session begins, a mother and daughter rant and rave at each

41
other while the father sits silently in the corner, it retain necessary to ask how involved he is at
home. In fact, asking may yield a less accurate picture than the one revealed spontaneously.

Diagnosing
It is necessary to have a formulation to organize strategies for change. Structural diagnostic
categories organize what otherwise may be confusing impressions without arbitral distorting the
dynamic aspects of family interaction. Families usually conceive of problems as located in the
identified patient and as determined by events form the past. The therapist regards the identified
patient symptom as an expression of dysfunctional transactional patterns affecting the whole
family. A structural diagnosis broadens the problem beyond individuals to family systems and
moves the focus from discrete events in the past to ongoing transactions in the present. A family
diagnosis is predicated on the goal of transforming the family in a way that benefits all the
family members. Structural therapists diagnosis in such a way as to describe the systemic
interrelationships of all family members. This diagnosis is based on observed interactions that
take place in the first session. In the later sessions, the formulations are refined and revised so
that they are increasingly more accurate. The structural diagnosis takes into account both the
problems that the family presents and structural dynamics that they display. Without diagnostic
formulation and a plan, the therapist is defensive and passive. Instead of knowing where to go
and moving forcefully, the therapist lays back and tries to cope with the family, put out bush
fires, and help them through a succession of incidents.

Highlighting and Modifying Interactions

Once families begin to interact, problematic transactions emerge and noticing them demands
focus on process not content. Family structure is revealed by who says what to whom and in
what way. Perhaps a husband complains. “We have a communication problem. My wife just
won’t talk to me, she never expresses her feelings.” The therapist then stimulates an interaction
to see what actually does happen

“Your husband says it’s a communication problem, can you respond to that? Talk to him.” If
they talk, the husband becomes domineering and critical while the wife grows increasingly silent
and withdrawn, then the therapist sees what goes wrong. The problem isn’t that she doesn’t talk,
which is linear explanation. The problem is that the more he nags, the more she withdraws, and
the more she withdraws, the more he nags. The therapist tries is to highlight and modify this
pattern of interaction using shaping competence. This alters the direction of flow. By
highlighting and shaping the positive, structural therapist use functional alternatives that are
already a part of their repertoire.

Boundary Making
Dysfunctional family dynamics are developed from and sustained by overly rigid or diffuse
boundaries separating subsystems in the family. Structural therapists intervene to realign the
boundaries by increasing either the proximity or distance between family subsystems. In highly
enmeshed families, the therapist’s interventions are designed to strengthen the boundaries
between subsystems and to increase the independence of individuals. Although structural family
therapy is begun with the total family group, subsequent sessions may be held with individuals or
sub-groups to strengthen the boundaries surrounding them. Disengaged families tend to avoid or
detour conflict and thus minimize interaction. The structural therapist intervenes to challenge

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conflict avoidance and to block detouring in order to help disengaged members increase contact
with each other. The therapist creates boundaries in the session, which permit family members to
discuss their conflicts without being interrupted. In addition, the therapists prevent escape or
avoidance, so that the disagreements can be resolved. Therapist creates a condition in which the
family members face each other squarely and struggle with difficulties between them.

Adding Cognitive Construction

Although structural family therapy is not primarily a verbal or cognitive treatment, its
practitioner’s use words and concepts to alter the way the family members perceive reality.
Minuchin says, “Reality is perspective” changing the way family members relate to each other
offers alternative views of reality. The converse it is also true: Changing the way family
members view of reality enables them to change the way they relate to each other. Sometimes
the structural family therapist offers information and advised based on training experience.
Information may be offered in order to restructure their interactions. When family members feel
embarrassed because they fight over little things, it may be helpful to tell them that most people
do. Sometimes young parents will profit from simple suggestions that they hire a baby sitter and
go out once in a while. Structural therapists also issue constructions to provide family members
with a different frame for experiencing. Paradoxes are cognitive constructions, which can be
used effectively to stimulate new interactional patterns.

32. 3. 08 HUMAN VALIDATION PROCESS MODEL

Historical Development of the Theory

This theory is called by many names including: Communication theory, Transformational
Systemic Therapy, Experiential theory Conjoint theory, Human Validation theory and
Transformational Systemic Therapy. This theory is rooted in humanistic approach of helping
people. What happens when a human being appears on the professional radar and, without
directly challenging the prevailing system, provides new possibilities and opportunities for
growth and human wholeness? Virginia Satir (1916 – 1988) was one such person when she
became one of the founders of the family therapy movement. She saw her first family in 1951
which was, at that time, against the therapeutic “rules” of the day. She taught her first family
therapy courses at the Mental Research Institute in California, U.S.A., in 1959. By 1964, her
ground breaking book, Conjoint Family Therapy, was published, establishing her as a pioneer in
new ways of helping people in need.

Satir was an ardent learner. As she learned, she continuously added to her approach, trying
new things, discarding old things and developing her system of becoming more fully human.
Yet, her basic underlying philosophy and the essence of her change process remained intact.
From observing Satir’s therapeutic work and analyzing her words, five therapeutic process
elements have been identified that are essential for the therapy to create transformational
change, a significant energetic shift. These therapeutic elements are necessarily present
throughout the entire therapy session from the initial contact and rapport building, through
assessment and exploration, goal setting, the transformational change process, anchoring the
changes, reviewing the session and assigning therapeutic homework for practicing and
integrating the changes. The five essential elements for transformational change are:

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 Experiential: The therapy must be experiential, which means that the client is experiencing
the impact of a past event in the present. As well, and at the same time, the client is
experiencing his/her own positive Life Energy in the present. Often, body memory is
accessed as one of the ways to help clients experience their impacts. It is only when clients
are experiencing both the negative energy of the impact and the positive energy of their Life
Force in the now that an energetic shift can take place.

Systemic: Therapy must work within the intrapsychic and interactive systems in which the
client experiences his/her life. The intrapsychic system includes the emotions, perceptions,
expectations, yearnings and spiritual energy of the individual, all of which interact with each
other in a systemic manner. The interactive systems include the relationships, both past and
present, that the person has experienced in his/her life. The two systems interact with each
other. A change in one impacts the other. However, transformational change is an energetic
shift in the intrapsychic system which then changes the interactive systems.

Positively directional: In the Satir Growth Model, the therapist actively engages with the
client to help reframe perceptions, generate possibilities, hear the positive message of universal
yearnings, and connect the client to his/her positive Life Energy. The focus is on health and
possibilities, appreciating resources and anticipating growth rather than on pathologizing or
problem solving.

Change focused: As the focus of Satir therapy is on transformational change, the process
questions asked throughout the entire therapy session are change related.

Self of the therapist: As previously mentioned, the congruence of the therapist is essential for
clients to access their own spiritual Life Energy. When therapists are congruent, clients
experience them as caring, accepting, hopeful, interested, genuine, authentic and actively
engaged. Therapists’ use of their own creative Life Energy in the form of metaphor, humor,
self-disclosure, sculpting, and many other creative interventions also comes from the
connection that therapists have to their own spiritual Self when in a congruent state.

Key Figures of the Theory

Virginia Satir (26 June 1916 – 10 September 1988) was an American author and social worker,
known especially for her approach to family therapy and her work with family reconstruction.
She is widely regarded as the "Mother of Family Therapy" Her most well-known books are
Conjoint Family Therapy, 1964, Peoplemaking, 1972, and The New Peoplemaking, 1988.

She was the eldest of five children born to Oscar Alfred Reinnard Pagenkopf and Minnie Happe
Pagenkopf. When she was five years old, Satir suffered from appendicitis. Her mother, a devout
Christian Scientist, refused to take her to a doctor. By the time Satir's father decided to overrule
his wife, the young girl's appendix had ruptured. Doctors were able to save her life, but Satir was
forced to stay in the hospital for several months.[7]

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A curious child, Satir taught herself to read by age three, and by nine had read all of the books in
the library of her small one-room school. When she was five, Satir decided that she would grow
up to be "a children's detective on parents." She later explained that "I didn't quite know what I
would look for, but I realized a lot went on in families that didn't meet the eye."

In 1929, her mother insisted that the family move from their farm to Milwaukee so that Satir
could attend high school. Satir's high school years coincided with the Great Depression, and to
help her family she took a part-time job and also attended as many courses as she could so that
she could graduate early. In 1932, she received her high school diploma and promptly enrolled in
Milwaukee State Teachers College (now University of Wisconsin–Milwaukee.) To pay for her
education she worked part-time for the Works Projects Administration and for Gimbels
Department Store and further supplemented her income by babysitting. She graduated with a
bachelor's degree in education, and worked as a teacher for a few years.

Key Concepts
a) Beliefs
For sustained effective use of the Satir model, practitioners must both know and value the
belief system. Perhaps the most important tenet is that everyone has the internal resources
needed for change and growth. Regardless of what else the therapist does, the primary intent
is to connect as early as possible to the core of each person. Connecting from and to this
place is enlivening for the client and therapist as a sense of well-being and wholeness
emerges. “It is something you can call ‘spirit,’ ‘soul,’ or whatever you want. In any case, it is
there and the only thing that really changes people is when they get in contact with their life
force.

Given that the quality of one’s relationships, performance and health are in large part
determined by one’s level of self-esteem, interactions with clients are oriented toward that end.
In this model, people come into the world with the birthright of self-esteem. Clients bring in
their problem but learn that the “problem” is not the problem, rather it is the coping. Problem
behaviors have purpose and no matter the level of dysfunction there is a seed of value and
potential in them. Perhaps the most challenging belief imbedded in the Satir system is that at
any moment in time, we are all doing the best we can. The therapist helps clients become aware
of and access their inner resources, gain new learning, practice new behaviors, and make
choices that result in healthier behaviors. In her first book, Satir postulated that “the most
important concept and touchstone in therapy is maturation: the state in which a given human
being is fully in charge of himself…able to make choices and decisions based on accurate
perceptions about himself, others and the context…while acknowledging, owning and
accepting responsibility for those choices and decisions” (Conjoint Family Therapy, 1964, pp.
117, 118).

b) Survival
The basic theories are sufficiently expansive as to provide a platform for understanding how
people become who they are and communicate in the ways that they do. In a sense people get
their first Ph.D. in life from what they learned during their early years when their sustenance
was dependent on the big people who were around and provided care. Children craft unique

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ways to cope with trying to get their needs met and not getting them met. The content of early
learnings, as well as the way they are taught, has relevance for one’s self-esteem and behavioral
effectiveness. The internal stress of growing up gets expressed outwardly in behaviors that are
designed for self-protection and preservation. Satir made distinctions between human systems
that modeled hierarchy, threat and reward and those that were organic and growth-oriented.
Through these ways of viewing the world one learns what it means to be a person, how to be in
relationship, as well as how to feel about change. These worldviews are foundational in shaping
the development of a person.

The child begins early on to develop a protocol or standard operating manual for dealing with
threat and vulnerability. Over time these behavioral reactions are coded into one’s internal
program and show up in patterned ways of communicating when one is stressed. Since these
behaviors worked for survival and were used many times, they become reflexive and
challenging to change. Therapy that merely seeks to change a specific behavior without
appreciating its historical value is not Satir work.

c) Communication
Communication is the milieu of relationships. Dysfunctional communication patterns emerge
from low self-esteem and can be understood by a simple Satir premise: the universe of one’s
reality can be divided into three parts: the Self, the other and the context. Accordingly, if one
can attend concurrently to each of these three spheres with care and respectfulness, then
congruent communication can happen. Satir observed that most people have great difficulty in
doing this when they are under stress. Though congruence offers individuals more satisfying
connections, better health and more effectiveness, the basic mode of operating when one is
feeling threat and low self-esteem has been constructed long ago. It is common to develop a
preferred orientation, or coping stance, which can be experienced, observed, felt and heard via
verbal and non-verbal information. Noting what is being discounted or over-emphasized
among one or two of the three components of congruence suggests that the communication is
placating, blaming, super-reasonable or irrelevant, according to Satir’s typology for defensive
stress stances. For example, when one is oriented towards the other, protection will likely be a
diminished assertion of the Self and a placating response emerges. When emphasis is on the
Self and the feelings, needs and thoughts of the other are discounted, the communication
reflects a blaming stance.

When conflict and chaos caused by the challenges of differing and opposing feelings and
positions are threatening, and one focuses only on context, the quality of the interaction is
much like a computer. This stance is called super-reasonable. This defense gives the individual
a surface experience of control and order. The content deals in this kind of interaction with
such things as facts, rules, regulations, time constraints, policy, precedent and purpose: all
things of the head. The irrelevant stance ignores the grounding boundaries of the Context.
Distracting and often humorous interactions emerge providing an immediate avoidance of the
difficult situation.

d) Congruence

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 Congruence offers one an experience of authenticity, a response that reflects a harmony
between one’s internal and external world and the self, other and context. These responses
exude balance, flow, integrity, understanding and compassion. They tend to invite mature
and engaging interactions that build trust and connection. Since neither the value of the
Self, the other or the Context is being squelched in the moment of the interaction, energy
flows naturally, often creating synergy and intimacy. One has the experience of freedom to
express one’s humanness and one’s true self; in other words, emotional honesty. The most
powerful intervention into a system happens when the therapist brings congruence to the
session and when the skills and value of congruence are taught.

Change
Satir provided practitioners a map to help them traverse the sometimes tricky and tumultuous
territory of change. Intentional change usually requires that a client feel the pain of the old
status quo while holding onto hope and vision for a better way to live. Grief is a part of that
process, as change requires a leaving or letting go of some aspect of an old way of operating.
The old status quo and its familiarity are comforting, but costly. Invited or not, foreign
elements come in the form of symptoms, major events of loss or gain, as well as therapy. The
foreign element shakes one’s grounding.

Chaos follows with its array of feelings: confusion, fear, sadness, excitement, etc. When
people feel this chaos they can continue to work toward a better future or they can return to
the old status quo. This process requires that one hold onto an awareness of the pain of the
past while having the necessary support to access one’s internal and external resources. With
this level of awareness and support, the client can proceed with openness to seeking a
transforming idea that brings forward a creative and innovative leap. This experience can be
birthed by reading, journaling, dreams, art, prayer, meditation, nature, music, intimacy,
therapy, etc. The new vision of doing business and living differently often feels like an “aha”
moment. It is as though the mind, body and spirit convey an affirming “yes!” This begins the
process of integration and ownership where the new conception is tried on for size. From here
the individual or system seeking change must practice the new behaviors. Over time the
performance of the individual, whether internally or externally, is improved and one arrives
at a new status quo. All along the journey of change, the therapist is not only assisting the
client with a specific change, but actively teaching the client about the process. The client
comes to appreciate that change is an inevitable part of living.

Therapeutic Goals/Therapists Function

a) Satir helped clients to enhance their self-esteem; that is how the person experiences
and judges him/herself in the present. It goes beyond how one feels about or perceives
himself; it is at the level of one’s essence and, therefore, is at the level of Being and
consciousness.

b) She encouraged clients to be choice makers personal towards freedom. One’s choices
are in the direction of health, happiness, peace and love.

c) She encouraged clients to be self-responsible. When we become responsible for our

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 internal world, we experience the vastness of our Being. We then become responsible
for our own growth towards becoming more fully human, as well.

d) Congruence is a deeply imbedded concept and goal of the Satir Growth Model.
However, congruence as a meta-goal implies that people can grow to be in harmony
with their own Life Energy and to experience the peace, joy, love and connection that
exist there. There is an expectation in the Satir Growth Model that therapists have
attained a fairly high level of congruence in their lives and can be congruent while
working with their clients.

Techniques and Practice of the Theory

Given the basic beliefs and premises of the model, there are infinite possibilities for
intervention. Only the creativity of the therapist and the quality of the client-therapist
relationship limit the multi-modal and multi-sensory experiences that can be offered.

a) The Self-Esteem Maintenance Tool Kit is a symbolic set of tools, each one useful in
building and maintaining self-esteem. The tools can be created and used in their concrete
forms—e.g. using a wand called a wishing wand can stimulate one’s awareness of one’s
hopes and wishes. Other tools in the kit can be used similarly. They are the golden key for
new possibilities, the detective hat for analytical thinking, the yes-no medallion for knowing
one’s true “yes” and true “no,” the courage stick for moving forward despite fear, and the
wisdom box, which connects one to the quiet, soul-filled inner voice.
b) The mandala offers a way of referencing parts of the self; the parts are physical, nutritional,
intellectual, sensual, contextual, interactional and spiritual. Similarly, Satir created a
psychodramatic process called “parts parties.” Its objective is to help a person gain
awareness of one’s parts, see them in action, and accept them. Working with the Iceberg, a
metaphoric map, helps clients appreciate the layers of one’s self from behavior, to feelings,
perceptions, expectations, yearnings and the deep spirit-filled place called the “I Am.”
c) Family reconstruction is also a psychodramatic process that allows a client, referred to as
the “star,” to accept the personhood of the parents, thus freeing the “star” for more
congruent and empowered living.
d) Meditations nurture the right brain’s powerful ability to stimulate and support change.
Using metaphor and imagery makes use of the brain’s plasticity with messages that affirm
the belief that the client, like all people, has a basic orientation toward growth and
wholeness. Satir’s meditations are filled with the model’s empowering beliefs, thereby
creating in the individual a valuing of one’s own uniqueness and humanness.
e) The exercise called “With whom am I having the pleasure” helps an individual become
aware of memories that cloud one’s ability to clearly see the person with whom they are
interacting in the present moment. Temperature Reading gives the individual, couple or
family a structure that tends to invite and prod individuals to share appreciations, new
information, puzzles, and complaints with recommendations, hopes and wishes. This tool
is used widely outside of the therapy room, in schools, management, project teams and
other groups who need a high quality of connectivity to accomplish their desired goals.
f) Sculpting, which can be utilized also with individuals, is particularly helpful in
externalizing the communication patterns among couples or families. Each of the four

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 incongruent stress stances as well as congruent responses carries with them a physical
posture that helps build awareness for what is happening, both at the “intra” and “inter”
personal levels. Sculpting the “stress-dance” reveals the defensive dynamics within the
system, supporting the development of awareness, which opens the possibility of choice.
e) Reframing: The Satir model emphasizes the importance of language and its influence on
one’s psyche and self-esteem. The technique of reframing is used to shift a potentially
negatively loaded comment to one that connotes a deeper, more positive and congruent
response that could not have been expressed due to limited ability, vulnerability or lack of
awareness.

Conditions for Change

Human beings are all unique manifestations of the same Universal Life Force. Through this
universal Life Energy, we can connect in a positive, accepting, loving way.

Human processes are universal; all human beings experience themselves through doing,
thinking, feeling, expecting, yearning and spiritual connection. Therefore, these human
processes can be accessed and changed regardless of different environments, cultures, and
circumstances.

People are basically good. At their core, essential level of Life Energy, people are naturally
positive. They need to find this internal treasure to connect with and validate their own self-
worth.

People all have the internal resources they need in order to cope successfully with whatever
situations life provides and to grow through them. All necessary internal resources reside
within, even those that people may have learned to judge in a negative way or those that are
as yet undiscovered.

The “problem” is not the problem; how people cope with their problem is the problem. How
seriously the person experiences the problem through the meanings they make, their worries
and their copings, impacts on how great a problem it becomes for them.

The symptom is the subconscious solution to the problem, even if it creates dysfunctional
patterns. It is the result of the person’s attempt to survive the pain of their
problem. Although the person’s perceived problem needs to be heard and validated,
therapeutic change needs to work on wholesome solutions from the person’s Life Energy and
yearnings.

Therapy needs to focus on health and possibilities instead of problems and pathology. Life
Energy is naturally positively directional and therapy needs to tap into the natural process of
human growth in a positive direction.

Change is always possible. Even if external change is limited, internal change is still possible.
We can learn to be consciously responsible for and decide how we will live on our insides, even
when the outside cannot change.

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We cannot change past events; we can only change the impact that the past events have had
on us. It is possible to resolve impacts from the past in order to live with more positive energy
and be free of old hurts, angers, fears and negative messages in the present.

People do the best they can at any moment in time. Even when they have done very negative or
destructive things, it is the best coping that they were capable of at that moment in time and is a
reflection of their level of self-worth. Therefore, there is no reason to blame them for their past
failures. Helping them experience their positively directional Life Energy will help them make
new choices for the present and future.

Feelings belong to us. We all have them and can learn to be in charge of them. We can be
responsible for them and make choices about them. We can listen to the positive life message
from our feelings and give ourselves the validation we need. We can choose to let go of
feelings that create negative energies and events and replace them with acceptance,
appreciation, forgiveness, love and peace.

Wholeness, growth and evolution are natural human processes and, therefore, need to be the
focus of any therapeutic change. Transformational change comes from the level of Life Energy
and is a part of natural human growth and evolution. It means that people are becoming more
of their true, spiritual Selves rather than their reactive, survival systems.

The therapist’s use of Self is the greatest therapeutic tool that the therapist has to create the
conditions to facilitate positively directional, transformational change. Therapists who
experience their own positively directional Life Energy are able to provide clients with
therapeutic relationships based on care, acceptance and new possibilities. The therapist
often experiences the positive nature of the client’s Life Energy even before the client does
and connects with the client at that level.

Hope is a significant component or ingredient for change to take place. When the therapist
experiences the positive nature of the client’s true Self, hope becomes a tangible aspect of the
therapeutic process and guides the way towards change.

33.3.09 BEHAVIORAL FAMILY THERAPY

Historical Development of the Theory

Ivan Pavlov is the father of behavior theory when he invented classical conditioning. In classical
conditioning, an unconditioned stimulus (UCS), such as food, which leads to a reflex
unconditioned response (UCR), like salivation, is conditioned with a conditioned stimulus (CS)
such as a bell. The result is that the conditioned stimulus begins to evoke the same response
(Pavlov, 1932).

In 1948, Joseph Wolpe introduced systematic desensitization, with which he achieved great
success in the treatment of phobias. According to Wolpe (1948) anxiety is a persistent response of
the automatic nervous system acquired through classical conditioning. Systematic desensitization
deconditions anxiety through reciprocal inhibition, by pairing responses incompatible with anxiety

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arousing stimuli. Systematic desensitization proved to be even more effective when it included
actual practice in approaching the feared object or situation (in vivo desensitization).

The application of classical conditioning to family problems was primarily in the treatment of
anxiety based disorders, including agoraphobia and sexual dysfunction, pioneered by Wolpe
(1958) and later elaborated by Masters and Johnson (1970). Effective behavioral treatment for
enuresis (nocturnal enuresis, or bed-wetting at night, is the most common type of elimination
disorder) was also developed using classical conditioning.

By far the greatest influence on behavioral family therapy came from B.F. Skinner’s operant
conditioning. The term operant refers to involuntary reflexes and the frequency of operant
responses is determined by consequences. Responses that are positively reinforced are repeated
more frequently and those that are punished or ignored will be extinguished. For example, a child
who throws tantrums and parents eventually give in, they would be taught to ignore the behavior
until it is completely extinguished. Operant conditioning is particularly effective with children
because parents have considerable control over reinforcers and punishments. Gerald Patterson, at
the University of Oregon, was the most influential figure in developing behavioral parent training.
Patterson and his colleagues developed methods for sampling family interactions in the home,
trained parents in social learning theory, developed workbooks (Patterson, 1971b) and worked out
strategies for eliminating undesirable behaviors and substituting desirable ones.

Robert Libermann introduced role rehearsal and modeling to family therapy. During the 1970s
behavioral family therapy evolved into three major packages: parent training, behavioral couple’s
therapy and sex therapy. The leading figures in behavioral couple’s therapy included Robert
Weiss, Richard Stuart, Michael Crowe, Ian Fallon and Gayola Margolin.

Key Figures of the Theory

Behavioral therapy was started by Ivan Pavlov when he initiated classical conditioning. Wolpe
introduced systematic desensitization he used in the treatment of phobias. Masters and Johnson
(1970) used behavioral methods in the treatment of sexual dysfunctions. Patterson and his
colleagues developed methods for sampling family, trained parents in social learning theory,
developed workbooks, and worked out strategies for eliminating undesirable behaviors and
substituting desirable ones. Robert Libermann introduced role rehearsal and modeling to family
therapy in the 1970s. The leading figures in behavioral couple’s therapy included Robert Weiss,
Richard Stuart, Michael Crowe, Ian Fallon and Gayola Margolin.

Key Concepts

Reinforcement and punishment: Consequences that accelerate a behavior are called reinforcers
and those that decelerate are called punishers. Some responses may not be recognized as operants-
something done to get something because people are not aware of the reinforcing payoffs eg.
Nagging and temper tantrums and the way they get reinforced.

Extinction occurs when no reinforcement follows a response. Ignoring it is, of course often the
best response to behavior you don’t like.

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Theory of social exchange: As behavior therapists shifted their attention from individuals to
family relationships, they came to rely on Thibaut and Kelley’s (1959) theory of social exchange
which posits that people strive to ‘maximize rewards’ and ‘minimize costs’ in relationships. In a
successful relationship both partners work to maximize mutual rewards. By contrast, in
unsuccessful relationships the partners are too busy trying to protect themselves from getting hurt
to consider ways to make each other happy. According to Thibaut and Kelley, behavior exchanges
follow a norm of reciprocity over time, so that aversive or positive stimulation from one person
tends to produce reciprocal behavior from the other. Kindness begets kindness; nastiness begets
nastiness.

Aversive control like nagging, crying, withdrawing-is often cited as a major determinant of
marital unhappiness. Spouses typically reciprocate their partner’s use of aversive behavior, and a
vicious circle develops. People in distressed relationships also show poor problem solving. When
discussing a problem, they frequently change the subject; they phrase wishes and complaints in
vague and critical ways; and they respond to complaints to counter complaints.

The Central Premises of behavior therapy

a) Behavior is maintained by its consequences in a more or less complex linear model.
Symptoms are learned responses that are caused by dysfunctional reinforcement (often
involuntary).
b) Behavior change is best brought about by accelerating positive behavior and decreasing
aversive control, as well as by improving communication and problem solving skills.
c) Treatment is usually time limited and symptom focused.
d) Therapist personality is not important, therapist action is
e) Focus on dyadic interactions primarily
f) Insistence on observation and empirical evaluation
g) Treatment is tailored to the specific family
h) Thibaut and Kelley's theory of social exchange (we act to maximize benefits and
minimize costs)

Therapeutic Goals/Therapists Function

a) Often begin with redefinition of the problem in terms of specific behaviors or conditions,
or in terms of positive behaviors to teach
b) Modify specific patterns of behavior to alleviate the presenting problem. This focus on
behavior rather than on the organization of the family or the health of its relationships
gives behavior therapy a more technical flavor.
c) Treatment is tailored fit to each family. Thus parents with a child with temper tantrums
might be taught to ignore the tantrums and reward the child for putting the feelings into
words.
d) Redefine a family’s goal to increase positive and incompatible behavior and decrease
negative behaviors
e) They aim at the system’s change and growth through increasing more rewarding behaviors

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 f) Teach communication, problem solving and negotiation skills

Techniques and Practice of the Theory

a) Behavioral Parental Training

Behavior therapists accept the parent’s view that the child has a problem (but not the problem)
and meets with the parents. The assumption is that the root of the child’s problems lies in
providing inconsistent or inappropriate consequences for problem behavior.

Assessment: In common with other behavior therapies, parent training starts with thorough
assessment
Shaping consists of reinforcing change in small steps
Token economies use points to reward children for successful behavior and taking away
rewards based on the positive behavior expected
Time out is a punishment where children are made to sit in the corner or sent to their rooms
Contingency contracting: Contracting is introduced as a way for everybody in the family to
get something by compromising. Teenagers and parents are asked to specify which
behavior they would like each other to change. These requests form the nucleus of initial
contracting. This entails: i) clear communication of content and feelings ii) clear
presentation of requests iii) negotiation, with each person receiving something in exchange
of some concession.

b) Behavior couples Therapy

Assessment: Behavioral couple’s therapy begins with an elaborate structured assessment. This
process usually includes clinical interviews, ratings of specific target behaviors and marital
questionnaires. The most widely used is the Locke-Wallace Marital Adjustment Scale (Locke
& Wallace, 1959), a twenty three item questionnaire covering various aspects like marital
satisfaction, communication, sex, affection, social activities and values. Assessments are
designed to reveal strengths and weaknesses of a couple’s relationship and the manner in
which rewards and punishments are exchanged.

Behavior exchange: procedures are taught to help couples increase the frequency of desired
behavior. Couples are asked to present their wishes specifically and behaviorally. While
explicitly exchanging strokes, couples implicitly learn ways of influencing each other through
positive reinforcement. An alternative tactic is to ask each partner to think of things the other
might want, do them and see what happens.

Quid pro quo contracts: One partner agrees to make a change after a prior change by the
other. Each partner specifies the desired behavior change and with the therapists help they
negotiate agreements.

c) Treatment of sexual dysfunctions

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 Thorough assessment: Masters and Johnson (1970) guided that the step in treatment of
dysfunctions is a thorough assessment, including a complete medical assessment and
extensive interviews to determine the nature of dysfunction and establish goals for
treatment. In the absence of organic problems, cases involving lack of information, poor
techniques, and poor communication are most amenable to sexual therapy.
Systematic desensitization: According to Wolpe most sexual problems are the result of
conditioned anxiety. Couples are asked to engage in a series of progressively intimate
encounters, while avoiding thoughts about erection and orgasm.
Assertive training: In assertive training, socially and sexually inhibited persons are
encouraged to accept and express their feelings
Sensate focus: Couples are taught how to relax and to enjoy touching and being touched.
They are told to find a time when they are both reasonably relaxed and free from
distraction, get in bed naked and take turns gently caressing each other…..starting with less
excitable to highly excitable parts. Thus, sensate focus is a form of in vivo desensitization.
Squeeze technique: In men, the most common problem is premature ejaculation, for which
part of the treatment is the squeeze technique in which the woman stimulates the man’s
penis until he feels the urge to ejaculate. At this point, she squeezes the frenulum (at the
base of the head) firmly between her thumb and first two fingers until the urge to ejaculate
subsides. Stimulation begins until the other squeeze is necessary.
Teasing technique: In this technique; the woman starts and stops stimulating the man. The
man begins intercourse with the woman guiding the man’s flaccid penis into her vagina.
Successful therapy usually ends with the couples sexual life much improved.

Conditions for Change

The basic premise of behavior therapy is that behavior will change when the contingencies of
reinforcement are altered. Behavioral family therapy aims to resolve specific targeted family
problems through identification of behavioral goals, learning theory techniques for achieving
these goals and social reinforcers to facilitate the process. Significant others are trained to use
contingency management techniques to influence family members and to provide appropriate
consequences for desired behavior. The hallmarks of family therapy are: i) careful and detailed
assessment to determine the baseline frequency of the problem behavior, to guide therapy, and to
provide accurate feedback about the success of treatment and ii) strategies designed to modify
the contingencies of reinforcement in each unique client family.

The first task of the therapist is to observe and record the frequency and duration of problem
behavior as well as the stimulus conditions that precede it and the reinforcement that follows it.
This enables the therapist to design an individually tailored treatment program. Studies showed
that reinforcement of positive behaviors like cooperation and compliance doesn’t lead to
reductions in antisocial behavior. Introducing punishment (time out, point loss) produces long
term reductions in anti-social behavior. When dealing with behavior problems a focus on the
family and wider context as a reinforcer of negative behaviors should be looked at (world of
peers school, community, religious gatherings etc).

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Most behavior family therapy uses operant rather than classical conditioning (with the exception
of treating sexual dysfunctions) and the focus is changing dyadic interactions (child-parent or
spouse –spouse). This dyadic focus differs from the triadic approach of systems oriented family
therapists.

A major tenet of behavioral family treatment is that behavior change is better achieved by
accelerating positive behavior than decelerating negative behavior. It’s believed that most
distressed families already use these approaches to excess. Therefore, only positive
reinforcement is widely used in behavior family therapy. Behavioral therapists directly
manipulate contingencies of reinforcement in the families they treat, and may provide
reinforcements themselves when family members comply with their instructions. Once new
behaviors are established, therapists counsel family members to use intermittent positive
reinforcement and then to fade out material reinforcements in favor of social ones.

In general, behaviorists deemphasize the ‘art’ of therapy treating instead as a technical procedure
dependent largely on the application of learning theory. Supportive therapeutic alliance is
essential for effective treatment is maintained by displaying respect for the family, reliably
adhering to the agreed on time and place and focus of therapy (this means not shifting from
parenting to marital problems without the explicit agreement of the couple), and appreciating that
family members are doing the best they can. The role of the therapist is not to confront the
inadequacies of these best efforts, but to facilitate efforts to overcome manifest efficient and to
improve efficiency of family members’ responses. Confrontation, coercion and criticism are
minimized and the therapist concentrates instead on validating the efforts family members are
making.

Bibliography

Locke, H.J., and Wallace, K.M. 1959. Short-term marital adjustment and prediction tests: Their
reliability and validity. Journal of marriage and family living. 21. 251-255.
Masters, W.H. and Johnson, V.E. 1970. Human sexual inadequacy. Boston: Little, Brown.
Patterson, G.R. 1971b. Families: Application of social learning theory to family life. Champaign,
IL: Research Press.
Pavlov, I.P. 1932. Neuroses in man and animals. Journal of the American Medical Association.
99: 1012-1013
Thibaut, J., and Kelly, H.H. 1959. The social psychology of groups. New York: Wiley
Wolpe, J. 1948. An approach to the problem neurosis based on the conditioned response.
Unpublished M.D. thesis. University of Witwatersrand, Johannesberg, South Africa.
Wolpe, J. 1958. Psychotherapy by reciprocal inhibition. Stanford, CA: Stanford University
Press.

32.3.10 COGNITIVE BEHAVIOR THEORY

Historical Development of the Theory

Despite the mechanistic sound of “schedules of reinforcement” and “controlling behavior,”

behavior therapists have increasingly become aware that people do not only act but also think and
feel. This recognition has taken the form of efforts to integrate stimulus-response behaviorism

55
(Skinner, 1953) with cognitive theories (Mahoney, 1977). The central tenet of the cognitive
approach is that our interpretation of the other people’s behavior affects the way we respond to
them. Among the most troublesome of automatic thoughts are those based on “arbitrary
inference,” distorted conclusions, shaped by a person’s schemas, or core beliefs about the world
and how it functions. What makes these underlying beliefs problematic is that although they are
generally not conscious, they bias how we approach and respond to everything and everyone else.

Margolin and Weiss (1978) first demonstrated the effectiveness of a cognitive component to
behavioral marital therapy by comparing couples treatment using a strictly behavioral approach
to the group that also received a cognitive component. The treatment that included a cognitive
restructuring proved significantly more effective than behavioral marital therapy alone. The
cognitive approach first gained attention as a supplement to behavioral oriented couples and
family therapy (Margolin, Christensen, & Weiss, 1975). Margolin and Weiss study (1978)
sparked intense interest in cognitive techniques with dysfunctional couples. This interest with
cognitive behavioral approaches to couples therapy eventually led to the recognition by
behavioral family therapists that cognition plays a significant role in the events that mediate
family interactions (Alexander & Parsons, 1982).

Although marital and family therapists began to realize decades ago that cognitive factors were
important in the alleviation of relationship dysfunction (Dicks, 1953), it took some time before
cognition was formerly concluded as a primary component of treatment (Munson, 1993). In a
classic study, Margolin and Weiss (1978) first demonstrated the effectiveness of a cognitive
component to behavioral marital therapy by comparing couples treatment using a strictly
behavioral approach with a group that also received cognitive treatment. It included cognitive
restructuring and it proved significantly more effective than application of behavioral treatment
alone. This interest in cognitive behavioral approaches to couples therapy eventually led to the
recognition by behavioral family therapists that cognition plays a significant role in events that
mediate family interactions. Although marital and family therapists began to realize decades ago
that cognitive factors were important in the alleviation of relationship dysfunction (Dicks, 1953),
it took some time before cognition was formally included as a primary component of treatment
(Munson, 1993).

Key Figures of the Theory

Cognitive behavior therapy refers to those approaches inspired by the work of Albert Ellis (1962)
and Aaron Beck (1976) that emphasize the need for attitude change to promote and maintain the
behavioral modification. Among the leaders of cognitive behavioral family therapy are Donald
Baucom at the University of North Carolina, Norman Epstein at the University of Maryland, and
Frank Dattilio at Havard Medical School and the University of Pennsylvania.

Key Concepts

According to cognitive behaviorists, the schemas that plaque relationships are learned in the
process of growing up. Some of these dysfunctional beliefs are assumptions about specific family
roles while others are about family life in general. These schemas are the underlying basis of the
“shoulds” self-fulfilling prophesies; mind reading; jealousy; and bad faith that poison relationships
by distorting family members’ responses to each other’s actual behavior.

56
The following eight types of cognitive distortions are taken from Datillio (1998).

1) Arbitrary inference: Conclusions drawn from the events in the absence of supporting
evidence. For example, a man whose wife irons his shirts in the morning concludes she
doesn’t care about his feelings while she may be doing that because that what she
witnessed the mother doing.
2) Selective abstraction: Certain details are highlighted while other important information
is ignored. For example, parents of a teenager may remember the times she defies them
and downplay times she goes out of her own way to please them.
3) Overgeneralization: Isolated incidents are taken as general patterns. For example, a wife
rejects a husband’s advances twice in a month and he concludes she has no interest for
sex while she has work issues that are disturbing her.
4) Exaggeration and minimization: The significance of certain events are unrealistically
magnified or minimized. For example, a husband considers the two times in one month
he shops for groceries to be enough while the wife thinks that he does nothing.
5) Personalization: Events are arbitrarily interpreted in reference to oneself. For example a
teenager wants to spend more time with his friends and the father concludes his son
doesn’t enjoy his company instead of seeing a person who is seeking more independence.
6) Dichotomous thinking: Experiences are interpreted as all good or all bad. Peter and
Jane have a measure of good times and bad times. Peter remembers the bad times while
Jane remembers the good times. Peter concludes that Jane is very unrealistic about many
situations and she has a tendency 1of amplifying situations.
7) Labeling: Behavior is attributed to undesirable personality traits. A woman who hardly
talks to her mother about her career because the mother always criticizes her is
considered “secretive.”
8) Mind reading: People don’t communicate because they assume others should know
what they are thinking. For example, a man doesn’t tell his wife that she cooks well
because he assumes that she knows he appreciates. He told a therapist once that she
pretends not to know.

Therapeutic Goals/Therapists Function

a) Identification of automatic thoughts that flash through their minds

b) Cognitive therapists help clients examine their irrational beliefs that are making relating in
healthy way and dealing with life’s issues impossible
c) They teach families how to use cognitive strategies to resolve problems that affect them
d) Forming a supportive therapeutic alliance that respects the family
e) Validating family members for the positive efforts they are making
f) Therapists role is to teach family that emotional problems are caused by unrealistic beliefs
and that by revising these self-defeating ideas, they may improve the quality of their lives

Techniques and Practice of the Theory

57
 a) Keeping a diary: Clients are asked to keep a diary to track down automatic thoughts and
related emotions and behaviors. By reshaping their thoughts, they change their emotions
and behaviors.
b) Challenging irrational family beliefs: Families sometimes present very unrealistic beliefs
and the therapist challenges these beliefs and helps the family members to adopt beliefs
that are healthy in facilitating it family growth and development.
c) Self-monitoring: Self-monitoring requires patients to observe and record specific
physiological, cognitive, behavioral, emotional, and interpersonal processes. Recording
these data points provides a springboard for intervention and anchors evaluation of
progress.
d) Self-instruction: Simply, self-instructional techniques target thought content (e.g.
automatic thoughts) and cognitive processes (e.g. cognitive distortions). They change
misappraisals of specific situations to more accurate explanations. Self-instructional
interventions work to change the nature of each family member’s internal dialogue.
Dattilio et al. (1998) recommend testing automatic thoughts in the presence of other
family members so they support each other’s restructuring efforts.
e) Rational analysis: In rational analysis, the patient collects the data and then crafts
conclusions and judgments, which make sense of new information. Patients objectively
evaluate the facts confirming or disconfirming their hypotheses about each other and craft
alternative explanations if their hypotheses are disconfirmed. Greco and Eifert (2004)
introduced several novel experiential methods well suited for rational analysis in
cognitive behavioral family therapy. These activities promote what Greco and Eifert
called “unified detachment.” Family members objectively view and interpret family data.
For example, Greco and Eifert suggested parents and children might draw, act-out, or
otherwise describe the color, shape, or texture of the family conflict. Each member’s
drawing or description is shared and members draw conclusions based on the incoming
data.
f) Behavioral enactment: Enactment can be regarded as a dance in three movements. In
the first stage, therapists conceptualize the family and fix their sights on which
maladaptive patterns to target. Next, therapists organize and set up the experiments or
situations, which will elicit the dysfunctional patterns. Third, therapists and families try
out alternative behaviors and interaction patterns in the situations. It is pivotal that a
cognitive behavioral family therapist learn first-hand the ways families work.

Conditions for Change

Barton and Alexander (1981) say that members of unhappy families tend to attribute their
problems to negative traits (laziness, irresponsibility, poor impulse control) in other members.
Such negative and incomplete views leave family members with a limited sense of control over
their lives. After all, what can one person do to another’s laziness, irresponsibility or poor
impulse control? Cognitive behaviorists believe that attribution shifts are necessary to make
behavior change possible but that behavior change is necessary to reinforce new and more

58
positive attributions. Change will occur if current behavioral principles are applied regardless of
the individual personality or style of therapy. Supportive therapeutic alliance is essential for
effective treatment by displaying respect for the family, reliably adhering agreeing on agreed on
time, place and focus of therapy. The role of the therapist is not to confront the inadequacies of
the family’s best efforts but to facilitate efforts to overcome manifest deficient and to improve
the efficiency of the family.

Confrontation, coercion and criticism should be minimized and therapists concentrate on

validating efforts family members are making (Falloon, 1991). Cognitive behaviorists have
become more concerned with resistance particularly as it pertains to homework assignments.
First, they see as a property of individuals rather than a homeostatic tendency in systems.
Second, they assume that although family members may have beliefs and expectancies that
interfere with change, these are relatively easily examined and reexamined. Once an individual’s
concerns are addressed, then therapy can continue. Rational emotive therapists use ABC theory
(the Activating event which leads to irrational Beliefs, which are then Challenged). Cognitive
behaviorists balance behavior with cognition and focus on patterns of family interaction.

Cognitive therapy as set out by Aaron Beck (1976) emphasizes schemas or core beliefs which
family members use to interpret and evaluate one another unrealistically. Beliefs, conscious and
unconscious passed down from the family of origin contribute to jointly held beliefs that lead to
the current family schema. To improve their skill in identifying automatic thoughts clients are
encouraged to keep a diary and jot down situations that provoke automatic thoughts and the
resulting emotional responses. The therapist’s role then is to ask a series of questions about these
assumptions, than challenge them directly.

Bibliography
Alexander, J., and Parsons, B.V. 1982. Functional family therapy. Pacific Groove, CA:
Brooks/Cole
Barton, C. and Alexander, J.F. 1975. Therapist skills in systems-behavioral family intervention:
How the hell do you get them to do it? Paper presented at annual meeting of the
Orthopsychiatric Association, Atlanta, Georgia
Beck, A.T. 1976. Cognitive therapy and the emotional disorders. New York: International
Universities Press.
Dattilio, F. M., Epstein, N. B., & Baucom, D. H. (1998). An introduction to cognitive behavioral
therapy with couples and families. In F. M. Dattilio (Ed.), Case studies in couples and family
therapy (pp. 1–36). New York: Guilford.
Ellis, A. 1962. Reason and emotion in psychotherapy. New York: Lyle Stuart.
Fallon, I. R.H., ed. 1998. Handbook of behavioral therapy. Handbook of family therapy, Vol.
II,A.S.Gurman and D.P. Kniskern, eds. New York: Brunner/Mazel
Greco, L. A., & Eifert, G. H. (2004). Treating parent-adolescent conflict: Is acceptance the
missing link for an integrative family therapy? Cognitive and Behavioral Practice, 11, 305–
314.
Margolin, G. and Weiss, R.L. 1978. Comparative evaluation of therapeutic components
associated with behavioral marital treatments. Journal of Consulting and Clinical
Psychology. 49: 760-762
Margolin, G., Christensen, A. and Weiss, R.L. 1975. Contracts, cognition and change: A
behavioral approach to marriage therapy, Counselling Psychologist, 5: 15-25

59
Mahonney, M. J. 1977. Reflections on the cognitive learning trend in psychotherapy. American
Psychologist, 32: 5-13
Skinner, B.F. 1953. Science and human behavior. New York: Macmillian

2.3.11 SOLUTION FOCUSED THERAPY

Historical Development of the Theory

Solution-focused brief therapy is an approach to psychotherapy based on solution-building rather

than problem-solving. It explores current resources and future hopes rather than present
problems and past causes and typically involves only three to five sessions. It has great value as a
preliminary and often sufficient intervention and can be used safely as an adjunct to other
treatments. Developed at the Brief Family Therapy Center, Milwaukee (de Shazer et al, 1986), it
originated in an interest in the inconsistencies to be found in problem behaviour. From this came
the central notion of ‘exceptions’: however serious, fixed or chronic the problem there are
always exceptions and these exceptions contain the seeds of the client's own solution. The
founders of the Milwaukee team, de Shazer (1994) and Berg (Berg, 1991; Berg & Miller, 1992),
were also interested in determining the goals of therapy so that they and their clients would know
when it was time to end! They found that the clearer a client was about his or her goals the more
likely it was that they were achieved. Finding ways to elicit and describe future goals has since
become a pillar of solution-focused brief therapy.

Since its origins in the mid-1980s, solution-focused brief therapy has proved to be an effective
intervention across the whole range of problem presentations. Early studies (de Shazer, 1988;
Miller et al, 1996) show similar outcomes irrespective of the presenting problem. In the UK
alone, Lethem (1994) has written on her work with women and children, Hawkes et al (1998)
and MacDonald (1994, 1997) on adult mental health, Rhodes & Ajmal (1995) on work in
schools, Jacob (2001) on eating disorders, O'Connell (1998) on counselling and Sharry (2001) on
group work.

SFBT developed into the fast, effective treatment modality it is today over approximately three
decades, and it continues to evolve and change in order to meet the needs of those in therapy.
Currently, therapists in the United States, Canada, South America, Asia, and Europe are trained
in the approach. The principles of solution-focused therapy have been applied to a wide variety
of environments including schools, places of employment, and other settings where people are
eager to reach personal goals and improve interpersonal relationships.

Key Figures of the Theory

The solution-focused brief therapy approach grew from the work of American social workers
Steve de Shazer, Insoo Kim Berg, and their team at the Milwaukee Brief Family Therapy Center
(BFTC) in Milwaukee, Wisconsin. A private training and therapy institute, BFTC was started by
dissatisfied former staff members from a Milwaukee agency who were interested in exploring
brief therapy approaches then being developed at the Mental Research Institute (MRI) in Palo
Alto, CA. The initial group included married partners, Steve de Shazer, Insoo Berg, Jim Derks,
Elam Nunnally, Marilyn La Court and Eve Lipchik. Their students included John Walter, Jane
60
Peller, Michele Weiner-Davis and Yvonne Dolan. Steve de Shazer and Berg, primary developers
of the approach, co-authored an update of SFBT in 2007, shortly before their respective deaths.

The solution-focused approach was developed inductively rather than deductively; Berg, de
Shazer and their team spent thousands of hours carefully observing live and recorded therapy
sessions. Any behaviors or words on the part of the therapist that reliably led to positive
therapeutic change on the part of the clients were painstakingly noted and incorporated into the
SFBT approach. In most traditional psychotherapeutic approaches starting with Freud,
practitioners assumed that it was necessary to make an extensive analysis of the history and
cause of their clients' problems before attempting to develop any sort of solution. Solution-
focused therapists see the therapeutic change process quite differently. Informed by the
observations of Steve de Shazer, recognizing that although "causes of problems may be
extremely complex, their solutions do not necessarily need to be".

Key Concepts/Tenets
SFT does not subscribe to the disease model that focuses on diagnoses and pathologizing clients.
Instead, clients are considered adept at solving their problems at all times since they are viewed as
having unique attributes, strengths, values, resources, positive qualities, and abilities essential for
successful resolution of problems. The focus on strengths, resources, and solutions instead of
client’s problem and pathology in SFT differentiates it from traditional therapies.

This is liberating for the therapists because it allows them to take a not-knowing, non-expert
stance, while still remaining curious and interested in exploring client strengths and past
successful handling of problems in order to help clients resolve their own problems. In focusing
on clients as experts of their lives, solution focused therapists reinstate the idea that clients hold
the key to solving their problems.

The therapists act as agents of change by assisting the clients in constructing their own solutions to
the identified problem. This frequently entails changing interactions in the context of the situation
in which the problem occurs, the perceptions and interpretations associated with the interactions or
situation which comprise the problem, or co-construction of alternate, problem-free futures which
are acceptable to the clients. Major tenets/concepts include:

a) If it isn't broken, don't fix it. This is one of the overarching tenets of SFBT in that if a
client has already solved a problem or in the process of resolution then it does not make
sense to attempt to intervene. Therapy is required when the problem is present.
b) If it works, do more of it. The role of the therapist is to encourage clients to continue
doing what is already working and to support them in the maintenance of these changes.
c) If it's not working, do something different. If an attempted solution does not work then
the client is encouraged to explore and try alternative solutions in order to resolve the
problem.
d) Small steps can lead to big changes. Clients are encouraged to set small, realistic,
behaviorally measured goals. This supports the assumption that small changes lead to
other changes in the system. Small steps keep the process of change manageable for
clients and allows for progress towards termination of therapy.

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 e) The solution is not necessarily directly related to the problem. Because SFT is a
present and future oriented model, therapy begins by having the client describe what will
be different when the problem is solved. This approach focuses on the strengths and
resources the client is already using when the problem is less frequent or not present. The
goal is to encourage the client to focus on what they will be doing or be able to do when
the problem is solved and identify times in their lives when this has already occurred.
f) The language for solution development is different from that needed to describe a
problem. Solution focused talk is positive, hopeful; future focused, and sends the
message that change can and will happen. On the other hand, problem focused talk is past
oriented and tends to imply problems are permanent.
g) No problems happen all the time; there are always exceptions that can be identified.
There are times in the client's life when the problem they come to therapy with is absent
or less severe. Exploring what it different during those times helps make small changes.
h) The future is both created and negotiable. Change is always happening and clients
have the ability and knowledge to change their future behaviors.

Therapeutic Goals/Therapists Function

a) To resolve presenting complaints by helping clients do or think something different so as
to become more satisfied with their lives
b) Help clients begin to shift their language from talking about problems to talking about
solutions
c) Help clients identify "exceptions," when things worked positive for them e.g. times when
some aspect of the client's goal was already happening to some degree, utilizing these to
co-construct uniquely appropriate and effective solutions.
d) Help clients identify positive directions for change in their life and to attend to changes
currently in process they wish to continue, SFBT therapists help clients construct a
concrete vision of a preferred future for themselves.
e) Help people experiencing difficulty find tools they can use immediately to manage
symptoms and cope with challenges
f) Help clients identify what they want different in their lives

Techniques and Practice of the Theory

The miracle question: A key element within this questioning is the 'miracle question' - a
question that encourages people to stop thinking about why they cannot achieve something and
instead picture how their lives could be if a miracle occurred. This helps them to view life very
differently and takes the focus off the cause of their problems. Instead emphasis is placed on
times when their problems are non-existent.

Ultimately, the miracle question enables the individual to picture a solution. Their responses are
expected to describe this solution in detailed behavioural terms, and this can have powerful
implications about their need to do something different. This is thought to pave the way for
small, realistic steps that will help them form an entirely different way of living. Some people
may even begin to implement some of the behavioural changes they have pictured.

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Exception questions: Exception questions allow people to identify with times when things may
have been different for them - periods in their lives that are counter to the problem they are
currently facing. By exploring how these exceptions happened, and highlighting the strengths
and resources used by the individual to achieve them, a therapist can empower them to find a
solution. Examples of exception questions a therapist may ask include:

 "Tell me about times when you felt happiest".

 "What was it about that day that made it a better day?"
 "Can you think of times when the problem was not present in your life?"

During this process the therapist will likely offer plenty of praise to encourage individuals to
project their exceptions into the future and feel more confident about using their strengths and
resources to achieve their new vision.

Scaling questions: Following miracle and exception questions, scaling questions will typically
be asked to invite those taking part to perceive their problem in terms of difficultly. This tends to
involve using a scale from one to 10 in which each number represents a rating of the problem
(one being the worst a situation could be and 10 being the best). By identifying where
an individual's problem lies in their mindset, a therapist can go about exploring where things
would need to be for them to feel that the aims of therapy have been met. From here they can
establish specific goals and identify preferred outcomes. Scaling questions can also prove useful
for tracking progress.

Coping and compliments: Looking for the client's strengths and resources and commenting on
them is an important part of a solution-focused therapy session. Sometimes clients’ lives are so
difficult that they cannot imagine things being different and cannot see anything of value in their
present circumstances. One way forward is to be curious about how they cope – how they
manage to hang on despite adversity.

Observation suggestions: When clients find it hard to identify examples of earlier successes or
exceptions to the problem, observation suggestions can be applied. Here is an example of this
intervention may be done: “Could you, between now and our next conversation, pay attention to
situations in which things are a bit better? … When you notice that things are better, could pay
close attention to what is different in that situation and to what you do different yourself? And
could you make a note of what is different and what you do that helps so that we can talk about
it, next time we meet?”. The observation task often has a surprisingly strong effect. The question
makes them notice more consciously what goes right in their lives. Usually, this helps them
become more optimistic and gain more confidence.

Normalizing: One of the nice things about the solution-focused approach is that it has many
subtle and effective techniques. One of them is normalizing. Normalizing is used to
depathologize people’s concerns and present them instead as normal life difficulties. It helps
people to calm down about their problem. It helps them realize they're not abnormal for having
this problem. Other people in their situation might respond the same. This is important, because
if they felt angry and they'd also feel their anger was pathological, they'd have two problems,
their anger and the fact that they behaved pathological. That their behavior would be

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pathological would be a surplus problem to the original problem (the thing they were angry
about). Normalizing helps to prevent this surplus problem from happening. By saying something
like: "Of course, you're angry, I understand. It's normal to be angry right now." You can help
people to relax and to move on relatively quickly beyond their anger.

Reframing: With reframing the professional gives a positive twist to the words or actions of the
client. He or she sees the positive meaning or intention in or behind the words of the client and
highlights that. Insoo Kim Berg once explained the concept of reframing nicely: "Reframing is
simply an alternate, usually a positive interpretation of troublesome behavior that gives a positive
meaning to the client's interaction with those in her environment. It suggests a new and different
way of behaving, freeing the client to alter behavior and making it possible to bring about
changes while "saving face". As a result, the client sees her situation differently, and may even
find solutions in ways that she did not expect."

Conditions for Change

SFBT, which aims to help people experiencing difficulty find tools they can use immediately to
manage symptoms and cope with challenges, is grounded in the belief that although individuals
may already have the skills to create change in their lives, they often need help identifying and
developing those skills. Similarly, SFBT recognizes that people already know, on some level,
what change is needed in their lives, and SFBT practitioners work to help the people in their care
clarify their goals. Practitioners of SFBT encourage individuals to imagine the future they desire
and then work to collaboratively develop a series of steps that will help them achieve those
goals. In particular, therapists can help those in treatment identify a time in life when a current
issue was either less detrimental or more manageable and evaluate what factors were different or
what solutions may have been present in the past.

This form of therapy involves first developing a vision of one’s future and then determining how
internal abilities can be enhanced in order to attain the desired outcome. Therapists who practice
SFBT attempt to guide people in therapy through the process of recognizing what is working for
them, help them explore how best to continue practicing those strategies, and encourage them to
acknowledge and celebrate success. In addition, practitioners of SFBT support people in therapy
as they experiment with new problem-solving approaches.

Bibliography

Berg, I. K. (1991) Family Preservation: A Brief Therapy Workbook. London: BT Press.

Berg & Miller, S. (1992) Working with the Problem Drinker: A Solution Focused Approach.
New York: Norton.
Jacob, F. (2001) Solution-Focused Recovery from Eating Distress. London: BT Press.
Lethem, J. (1994) Moved to Tears, Moved to Action: Brief Therapy with Women and Children.
London: BT Press.
Miller, S., Hubble, M. & Duncan, B. (eds) (1996) Handbook of Solution-Focused Brief Therapy.
San Francisco, CA: Jossey-Bass.
Miller, W. R. & Rollnick, S. (1991) Motivational Interviewing: Preparing People to Change
Addictive Behaviour. New York: Guilford Press.
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O'Connell, B. (1998) Solution-Focused Therapy. London: Sage.
Sharry, J. (2001) Solution Focused Groupwork. London: Sage.

32.3.12 ECLECTIC APPROACH

Historical Development of the Theory

In breaking with the dominant paradigm of the time, family therapists defined themselves in
opposition to all things psychoanalytic. In any field of endeavor, it seems that integration is only
possible after a period of differentiation. At a time when the energies of emerging schools was
devoted to differentiating, integration was seen as a watering down, rather than enrichment, of
classic models. With time, there has been growing awareness that no single approach has a
monopoly on clinical effectiveness. The time of distinct and competitive schools of family therapy
has passed and as family therapy enters its fifth decade, the dominant trend is integration (Nichols
& Schwartz, 2006). The obvious argument in favor of incorporating elements from different
approaches is that human beings are complicated-thinking, feeling and acting-creatures who exist
in a complex system of biological, psychological and social influences. Integration then is crucial
and refers to three different kinds of approaches. First, eclecticism, which draws from a variety of
models and methods; then is the selective borrowing, in which relative purists use a few
techniques from other approaches. Third are specifically designed integrative models.

Key Figures of the Theory

Of the three approaches, that is eclecticism, selective borrowing and specifically designed
integrative models. Approaches of William Nichols (1995) and Bill Pinsof (1995); pragmatic
models that combine elements of two complementary approaches, such as Eron and Lund’s (1996)
narrative solutions therapy and Jacobson and Christensen’s (1996) integrative couple’s therapy:
and integrative models developed for specific clinical problems, such as Virginia Goldner and
Gillian Walker’s couple’s therapy for marital violence (Goldner, 1998).

Key Concepts

There are three approaches of integration namely eclecticism, selective borrowing and specifically
designed integrative models. Eclecticism is the effective integration involves more than taking a
little of this and a little of that from various models. In creating a workable integration, there are
two things to avoid. The first is sampling techniques from diverse approaches without conceptual
focus and the second and switching horses midstream.

a) Selective Borrowing

To borrow selectively, you need a solid foundation on particular paradigms is necessary. Effective
borrowing doesn’t mean a hodgepodge of techniques, and it doesn’t mean switching from one
approach to another whenever therapy reaches a temporary impasse. Borrowing techniques from
other approaches I more likely to be effective if you do so in a way that fits into the basic
paradigm within which you are operating.

b) Specifically Designed Integrative Models

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While some practitioners eventually become selective borrowers, grafting ideas and practices onto
their basic model, some therapists create a new synthesis out of contemporary aspects of existing
models.

Comprehensive, Theoretically Inclusive Models

It means not limiting one’s practice to any one model but drawing on a variety of existing
approaches. The advantage of these comprehensive approaches is that they bring a wider range of
human experience into focus. Therapists just can’t work on disentangling members, they have to
consider a variety of other issues including intrapsychic, trans- generational, political and a range
of other issues. Here l present two examples of models designed to increase comprehensiveness.
First is the meta-frameworks which selects key ideas that run through different schools of family
therapy and connects them with super ordinate principles. The second, integrative problem
centered therapy, links different approaches in sequence and provides a decision tree for shifting
from one to another when therapists get stuck

The Meta-frameworks Model

It grew out of collaboration among three therapists who worked at juvenile institute research in
Chicago: Douglas Breunlin, Richard Schwartz and Betty Mac Kue-Karrar. The approach offers a
unifying theoretical framework operationalized with six core domains of human functioning, or
meta-frameworks: intrapsychic process, family organization, sequences of family interaction,
development, culture and gender (Breunlin, Schwartz, & Mac Kune-Karrer, 1992). It can be
confusing to apply it but it offers a range of therapeutic alternatives.

Integrative Problem –Centered Therapy

Whereas meta-frameworks distills key elements from different theories into a new synthesis,
integrative problem centered therapy incorporates a variety of family and individual approaches in
sequence, without trying to combine them. Integrative problem centered therapy has been
developed over the past twenty years by William Pinsof (1999) and his colleagues at the Family
Institute at Northwestern University. Pinsof believed in strategic family therapy and he used it to
help families resolve their issues but when he started experiencing its limitations he borrowed
whole approaches like Human Validation by Virginia Satir to help him explore communication
and emotions.

Models that Combine Two Distinct Approaches

Some theorists who found one approach too limiting were satisfied to improve their model by
combining it with just one other, believing that two heads were better than one-and probably also
better than five or six.

The Narrative Solutions Approach

Eron and Lund’s narrative solutions model combind the MRI model with narrative techniques
(Eron & Lund, 1996). Among the reasons strategic therapy fell into disfavor were its mechanistic
assumptions and manipulative techniques. The way some strategists applied the cybernetic model,
families were seen as stubborn and not to be reasoned with. Joseph Eron and Thomas Lund of the

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Catskill Family Institute in New York began collaborating in the early 1980s as brief strategic
therapists. Although they were attracted to the narrative movement, there were elements of the
strategic approach they didn’t want to give up hence they combined the two. The resulting
narrative solutions approach revolves around the concept of preferred view. According to them,
problems arise when people do not live according to their preferred view. They urged therapists to
maintain interest in clients’ preferences and hopes. The therapist must pay attention to stories that
reflect how clients prefer to see themselves, and how they want to be seen by significant others.

Integrative Couples Therapy

Neil Jacobson of the University of Washington, one of the prominent behavioral family therapists
teamed up with Andrew Christensen of UCLA to figure out how to improve the limited success
rates they were finding with traditional behavioral couples therapy that was based on behavior
exchange model. They brought in the element of support, empathy and acceptance.

To create conducive environment, this approach begins with a phase called the formulation, which
is aimed at helping couples let go of blaming and open themselves to acceptance and personal
change. The formulation consists of three components: a polarization process that describes their
destructive patterns of interaction; the mutual trap which is the impasse that prevents the couple’s
from breaking the polarization cycle once triggered. Strategies to produce change include two
basic ingredients of behavioral couples’ therapy: behavior exchange and communication skills
training. Communication training involves teaching couples to listen and express themselves in
direct but non blaming ways and learning to use ‘I’ statements in conversations.

Jacobson and Christensen’s amalgamation also involved compatible marriage candidates-

behavioral and experiential. Both models are concerned with communication; they just have
different emphases.

Other Integrative Models

Brief Integrative Marital Therapy

One particularly elegant model that has been around for a while (since 1981) is Allan Gurman’s
brief integrative marital therapy which combines social learning theory and psychodynamics.
Marital problems are seen to be caused by poor communication and poor problem solving, but as
in object relations theory, these deficient are understood as having roots in unconscious conflicts.
Gurman (2002) describes a case in which Sue is angry and critical of Karl’s unavailability.
Gurman sees Sue’s attacking as serving the defense function of avoiding dealing with her own
fears of abandonment. Like a behaviorist, Gurman also looks at the consequences of the couple’s
problematic interaction, noting what positive and negative reinforcements or punishments are
maintaining these patterns.

Scot Henggeler’s Multisystemic model and Howard Liddle’s Multi- Dimensional Family Therapy

These two approaches evolved from research projects with difficult adolscents, a population that
challenges theorists to expand their views beyond the limits of one school of therapy or one level
of system (Henggeler & Borduin, 1990; Liddle, Dakoff & Diamond, 1991). Liddle’s
multidimensional family therapy brings together the risk factor models of drug and problem

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behavior, developmental psychopathology, family systems theory, social support theory, peer
cluster theory and social learning theory. In practice, the model applies a combination of structural
family therapy, parental training, skills training for adolescents and cognitive behavioral
techniques. Scott Henggler of the University of South Carolina and colleagues improved on their
systems oriented therapy by i) working with extra familial contexts like schools and peer contexts
ii) including individual developmental issues in assessments iii) incorporating cognitive behavioral
interventions.

Models Designed for Specific Clinical Problems

One sign that family therapy was maturing was when therapists began focusing on specific clinical
problems rather than generic families.

Working with Family Violence

One of the most impressive integrative efforts is the approach to treating spouse abuse developed
by Virginia Goldner and Gillian Walker at Ackerman Institute in New York (Walker & Goldner,
1995). They share the feminist conviction that the man was responsible for the violence and they
insist the he must stop the violence immediately. They use the language of ‘parts’ to help partners
detach from the labels, ‘abuser’ and ‘victim’ as they bring in intrapsychic insights into the
conversation. Active listening is used to get couples talk about themselves.

Community Family Therapy

Therapists find it very difficult to work with impoverished families. But Ramon Rojano has
motivation for this population. He says the greatest challenge for poor people is helplessness from
being controlled by a multitude of dehumanizing bureaucracies. He helps people to feel connected
to their communities and empowered to advocate for what they need. Rojano also recognizes that
community empowerment is not enough without ongoing family therapy.

Therapeutic Goals/Therapists Function

a) The therapist heightens the clients’ preferences and hopes and helps families to determine
ways of achieving them
b) Using various dimensions from different approaches patterns, emotions and blocks to
functionality of families are examined and helped to liberate themselves from such
impeding situations in order to actualize.
c) Facilitate working with information from extra familial contexts like community, schools
and other institutions
d) Elements from various approaches are combined to maximize their usefulness

Techniques and practice of the theory

a) Maintaining clients’ preferences and hopes

b) Explore the effects of behavior: Therapist helps clients examine the effects of their
behavior on themselves and others

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 c) Use past and present stories: The therapist helps clients find past and present stories that
are in line with their preferences and that contradict problem maintaining behavior
attributes (hard working, productive) wind up in Y situation (acting listless, feeling
depressed) and being seen by people in Z ways (uncaring, lazy)? The questions should be
asked in a puzzled not confrontational way.
d) Pose mystery questions: The therapist asks clients mystery questions-for example, how did
a person with X preferred
e) Coauthor alternative explanations: The therapist works with clients to develop new
explanations for the evolution of the problem that fits with how they prefer to be seen, and
inspires new actions.
f) Discuss the future: The therapist asks clients to imagine what the future will look like
when the problem is resolved

Conditions for change

Valuable as integrative efforts are, however, there remains a serious pitfall in mixing ingredients
from different approaches. The trick is to find a unifying conceptual thread. A successful
integration draws on existing therapies in such a way that they can be practiced coherently within
one consistent framework. Adding techniques haphazardly does not work. To succeed, a
synthesizing effort must strike a balance between breadth and focus. Breadth is particularly
important when it comes to conceptualization. Contemporary family therapists are wisely
adopting a broad, bio-psychosocial perspective in which the biological, relational, psychological,
relational, community and even societal processes are viewed as relevant to understanding
people’s problems. When it comes to techniques, most effective approaches don’t overload
therapists with scores of interventions.

Finally, an effective integration must have clear direction. The trouble with being too flexible is
that families have strong and subtle ways of inducting therapists into their habits of avoidance.
Good family therapy create an environment where conversations that should happen at home, but
don’t can take place. These dialogues however won’t happen if therapists abruptly shift from one
type of intervention to another in the face of resistance. Family therapy is ultimately a clinical
enterprise; its worth is measured in results. The real reason to combine elements from various
approaches is to maximize their usefulness, not merely their theoretical inclusiveness; for its
better to be effective than to look marvelous.

Bibliography

Breunlin, D., Schwartz, R., and Mac Kune-Karrer, B. 1992. Metaframeworks: Transcending the
models of family therapy. San Francisco: Jossey-Bass
Eron, J., and Lund, T. 1996. Narrative solutions in brief therapy. New York: Guilford Press
Goldner, V., Penn, P., Sheinberg, M., and Walker, G. 1990. Love and violence: Gender
paradoxes in volatile attachments. Family process. 29: 343-364.
Gurman, A.S. 2002. Brief integrative marital therapy: A depth-behavioral approach. In clinical
handbook of couple therapy, 3rd. ed., A.S. Gurman and N.S. Jocobson, eds. New York:
Guilford Press

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Henggeler, S., and Borduin, C. 1990. Family therapy and beyond: A multisystemic approach to
treating the behavior problems of children and adolescents. Pacific Grove, CA: Brooks/Cole
Jacobson, N., and Christensen, A. 1996. Integrative couple therapy. New York: Norton
Liddle, H.A. 1984. Toward a dialectical-contexual-coevolutionary translation of structural
strategic family therapy. Journal of Strategic and Systemic Family Therapies, 3: 66-79
Nichols, P.M. & Schwartz R. C. (2006). Family Therapy: Concepts and Methods (7th ed.).
London: Pearson.
Nichols, W.C. 1995. Treating people in families: An integrative framework: Guilford Press
Pinsof, W. 1995. Integrative problem-centered therapy. New York: Basic Books
Pinsof, W. 1999. Choosing the right door. Family Therapy Networker, 23: 48-55
Walker, G., and Goldner, V. 1995. The wounded prince and the woman who love him. In
Gender and power in relationships, C. Burcke, and B. Speed, eds. London: Routledge, Chapman
and Hall.

32.3.13 EMERGING ISSUES AND TRENDS IN THEORIES OF MARRIAGE AND

FAMILY THERAPY
Challenges Posed by Emerging Issues and Trends in Theories of Marriage and Family
Therapy
a) Getting overwhelmed by the multidimensional way of looking at problem development in
marriage and family therapy
b) Chaotic integration of marriage and family therapy approaches
c) Developers of particular theories down playing and irrationally challenging the value of
other approaches hence causing confusion to emerging therapists
d) Lack or limited scientific evaluations to determine efficacy and success of particular
theories
e) Changes and emerging issues and trends in families and marriages far outweigh the
developments in clinical practice. In some situations, therapists are overwhelmed and in
others there are limited funds set aside for scientific studies towards development of
evidenced based practice.

Ways of Coping with Challenges Posed by Emerging Issues and Trends in Theories of
Marriage and Family Therapy
a) Opening more forums like workshops, seminars and conferences to discuss and
interrogate emerging trends and issues in theories of marriage and family therapy.
b) Focus on existing theories and their potential for tackling emerging trends and issues and
gaps that require address
c) Setting aside funds towards scientific research on more effective approaches to deal with
emerging trends and issues or even modification of the same.
d) Therapists continually evaluating the success of current approaches and advancing
personalized perspectives of dealing with such cases which are cognizant of international
conventions regarding addressing issues
e) Attending trainings on the emerging issues and trends to gain knowledge, perspectives,
attitudes and skills to inform practice

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f) Attend clinical supervision while handling emerging issues and trends so that
interventions can be examined and re aligned to effective practice.

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