Family Therapy: Six Main Approaches

This purpose of this assignment is to provide an outline of the major concepts of six different systemic family therapy approaches including: adlerian family therapy, multigenerational therapy, the human validation process model, experiential symbolic family therapy, structural family therapy and strategic family therapy. A brief overview of each modality will be given and then an exploration of the value of working systemically with the case study of Stan will be made.

In addition, two social construction therapies, including solution focused therapy and narrative therapy will be reviewed and then finally these therapies will also be applied to the case study of Stan.

PART A- SYSTEMIC THERAPIES

A systemic perspective holds the assumption that an individual is best understood in the context of their family system. Family members interactions and behaviours are interconnected with others within the family and symptoms are often viewed as an expression of patterns within a family (Corey, 2005, p. 424).

In this section, six different systemic family therapies will be outlined and the case study of Stan will be discussed from a systemic perspective.

Adlerian Family Therapy: Alfred Adler was an Austrian Doctor and Psychologist who was one of the first members of Freud’s Vienna Psychoanalytic Society in the early 1900’s (Goldenberg & Goldenberg, 2008, p. 151). He later diverged from Freud’s theories, as he perceived man as a social being with a natural inclination toward other people. He maintained that to understand an individual we needed to understand them within the social context that they exist (Adler, 1929, pp.

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0-116). Adler was interested in a client’s social perspective and sense of community, birth order and family relationships and family constellations (ibid). Adler’s theories evolved from the concept of an inferiority complex which he believed motivates us to strive for success and work towards life goals that will see us overcome this complex (Corey 2005, pp. 94-95). Adlerian Family Therapy is referred to as teleological. That is a belief that we are motivated by our future and drawn to our goals and life purpose, rather than driven by our instincts or past trauma as was believed by Freud (Boeree, 2006).

The stages of Adlerian Family Therapy can be described as Relationship, Psychological Investigation, Interpretation and Reorientation (Sweeny 1989, pp. 239-260). The basic aims of the therapist are establishing and maintaining a good relationship with the client, exploring the dynamics of a person by looking at their birth order characteristics and assessing their lifestyle, encouraging the development of insight and helping the family to set new goals that are aligned and encourage cooperation, self esteem and social interest (ibid). Adler considered encouragement to be the essential element in working towards change with a client.

He believed that people who feel encouraged are more likely to accept themselves and strive for improvement (Sweeny 1989, pp. 239-260). Adlerian Family Therapists assume roles of educators, motivational investigators and collaborators. They will identify and discover the meaning of transactional patterns, set homework, teach new skills, promote effective parenting and build family pride with an emphasis on “changing the system and individual functioning within a new system” (Sherman & Dinkmeyer, 1987, p. 39). Multi-generational Family Therapy:

Murray Bowen was a psychoanalytically trained American psychiatrist who used a multigenerational approach when working with individuals (Brown, J. 2007, p. 12). The major concept of his theory is Differentiation of Self, which refers to the degree to which a person can think, act and follow their own values without having their behaviour automatically driven by the emotional cues of others (Bowen, 1994, pp. 476-477). Bowen maintained that levels of differentiation, patterns of behaviour and ways of relating to others are passed down through multiple generations and he described this as the Multigenerational Transmission Process (ibid).

He also emphasised the role that Triangles, or three-way relationships, play in diffusing anxiety within a system and he used the term Nuclear Family Emotional System to explain patterns of emotional interaction that occur within a family to manage or absorb anxiety (ibid). Other concepts in this theory include: The Family Projection Process or the process of parents transmitting their own low level of differentiation onto the most susceptible child (Bowen, 1978, p. 204); Emotional cutoff which refers to a person emotionally distancing themselves in an attempt to reduce their anxiety (Bowen, 1978, p. 35); Sibling Positions which illustrate that similar characteristics are found among people who share the same order of birth and the final concept of Bowen’s Theory is Societal Emotional Process which refers to the way increased levels of anxiety within society are managed resulting in both progressive and regressive periods (Bowen & Kerr 1988, p. 334) The main goal of Multi-Generational Therapy is to reduce chronic anxiety by increasing levels of differentiation and awareness of how the individuals emotional system functions (Goldenberg & Goldenberg, 2008, p. 195).

Reflections are not on the individual’s intra-psychic processes but on their own family’s intergenerational patterns of relationships (ibid). The therapist adopts a neutral and objective position acting as a coach. They assist family members to become their own researchers in their patterns of functioning within the context of their family system using genograms, homework and visits to family of origin (Goldenberg & Goldenberg, 2008, p. 197). Human Validation Process Model: Virginia Satir was an American social worker, therapist and writer and is considered a pioneer in the development of family systems therapy.

Her Human Validation Process Model grew from her desire to bring each family to its inherent potential and thereby achieve family ‘wellness’ (Goldenberg & Goldenberg, 2008, p. 222). Her approach emphasises congruent communication, emotional experiencing and building the self-esteem of each family member as essential components to the therapy (ibid). Satir believed the relationship between the therapist and the family was more important than any techniques being used and she thought of the therapist as a model of effective communication and a resource for developing ways to express emotions (ibid).

Jordan (2008, p. 313) illustrates the five major concepts of the Human Validation Process Model. These include: A focus on health and growth as apposed to pathology; the role of the therapist as being helping individuals to draw on their intrinsic resources to develop coping skills; symptoms and dysfunctional behaviour result from these internal resources being constrained through rigid beliefs and unrealistic expectations; systems operate with universal principles; and change is always possible and can be most effectively activated when therapists work with process rather than content.

Satir used an intergenerational approach to discover family patterns and worked under the premise that our behaviour reflects what we have learned, learning is the basis of behaviour and thus to change behaviour we have to have new learning (Corey, 2005, pp. 183-185). To accomplish new learning Satir believed in creating a nurturing context where the relationship between the therapist and the family was of primary importance. Some of the various techniques Satir used included humour, touch, role-playing, reframing, family reconstruction, and family sculpture (ibid).

Experiential Symbolic Family Therapy:

Carl Whitaker was an American psychiatrist who is also considered a pioneer in family systems therapy. Corey (2005, pp. 183-185) describes the goals of experiential symbolic therapy, as being to increase awareness of one’s present experiencing, facilitating individual growth and more effective interactional patterns, and promoting authenticity. Whitaker’s approach was unorthodox, active and confronting and he believed that to bring about change and flexibility within a family, the therapist needed to be personally involved in the therapy (Goldenberg & Goldenberg, 2008, p. 08). He stressed the importance of the therapist finding a balance between strong emotional confrontation and warmth and support. Several generations of a family are included in the therapy as Whitaker considered the family as an integrated whole, not as a collection of individuals. He also pioneered the use of co-therapists as a means of maintaining objectivity while using his highly provocative techniques to turn up the emotional temperature in families (ibid). Whitaker viewed family therapy occurring across several different stages (Goldenberg & Goldenberg, 2008, p. 15). The engagement phase sees a battle for structure ensue. During this phase it is the therapists role to set minimum standards and take control of the therapy. Following this phase a battle for initiative often sees a family become eager for the therapist to fix them or provide them with solutions but instead they are introduced to change through confrontation, exaggeration, anecdote and play. As the family progresses to a stage where they only require minimal intervention, the therapist can become more creative and provoke more spontaneous responses.

Finally as the family begins to utilise more of their own resources and take on increased responsibility for their way of living the therapy moves to the separation phase where there can often be a sense of loss and sadness over the therapy terminating (ibid). Structural Family Therapy: The development of the structural approach began with Argentinean family therapist, Salvador Minuchin in the early sixties (James & MacKinnon, 1986, p. 223). This approach views behaviour as a response the familial and social system in which it occurs.

Problematic behaviour is maintained, not caused by the system and often only presents when the system is faced with major stresses or transitional periods (ibid). Structural family therapy views the family in terms of structure, subsystems, boundaries and hierarchies. Structure describes the repeated patterns that define family relationships, and includes the rules that govern behaviour and dictate the assumption of roles and functions. The hierarchical structure of the family describes the framework of authority, which in turn determines how conflict will be mediated (Sholevar & Schwoeri, 2003, p. 40).

Structural family therapy is more action focused rather than insight oriented. The therapeutic relationship in structural therapy is not emphasised. Rather a therapist will join the family system and attempt to manipulate structures, regulate intensity, and modify dysfunctional patterns with techniques such as reframing, enactment, unbalancing hierarchies and tracking of transactional sequences (Corey, 2005, pp. 183-185). Fundamental goals of this therapy are to transform the systems homeostasis, or the desire to maintain stability or the status quo, develop new structures and altering the family’s transactions (Sholevar & Schwoeri, 2003, p. 9). Strategic Family Therapy: Jay Haley was an American Psychologist and Family Therapist who began working with Salvador Minuchin at the Philadelphia Child Guidance Clinic in the late 1960’s (Corey, 2005, p. 429). Their work was very similar and widely practised by family systems therapists during the 1970’s. Both the Structural and Strategic models are directive and seek to modify maladaptive structures or interactional sequences within families. Similarly insight is considered unimportant and the therapeutic relationship is not considered a major component of the therapy (ibid).

The structural and strategic models differences lie in the way that the family’s problems are viewed. Whilst Minuchin viewed a family’s symptoms as involuntary, Haley viewed a family’s symptoms or problems as an adaptive strategy that served a function in the system (Goldenberg & Goldenberg, 2008, p. 277). Cloe Madanes is an American Family Therapist and Psychologist who joined her husband, Jay Haley in 1975 to form the Family Therapy Institute of Washington DC (Goldenberg & Goldenberg, 2008, p. 277). The Haley-Madanes approach sees therapists working directively as consultants and experts.

Therapy is carefully planned and goals are set to alleviate the presenting problem and problematic family structures are explored. (Goldenberg & Goldenberg, 2008, p. 275). The primary goal of the interventions carried out by the therapists is to shift the family structures so that symptoms or the presenting problem no longer serves a function within the system (ibid). Working Systemically with Stan Corey (2005, pp. 10-15) presents a case study of a Stan, a 25-year-old male who has been mandated to attend counselling after a drink driving offence.

Stan has presented as a psychology student, working in construction with problems with relationships and alcohol. As Stan has identified that most of his relationships with other people are difficult, especially those with his family of origin, working with him from a systemic perspective could be particularly beneficial. Stan has commented “although I’d like to have people in my life, I just don’t know how to go about making friends or getting close to people” (Corey, 2005, p. 14). Working systemically would assist Stan in gaining insight into his interpersonal style and how this affects his relationships.

Family of origin work would provide Stan an opportunity to discover patterns of interacting that occur within his family across multiple generations. He would learn rules within his family that have dictated decisions that he has made in his life with people outside of his family and it would provide him with clarity around the difficulties he has with getting close to people. By constructing a genogram of Stan’s family it would allow him to see very clearly that problems with alcohol are a prominent pattern within his family of origin.

This may be new information to Stan that he may not have conceptualised before seeing the pattern depicted visually, even if he had an awareness of particular family members who drank heavily. The genogram would be a useful tool in providing Stan many other hypotheses that could help him to comprehend some of the underlying emotional processes that occur within his family (Goldenberg & Goldenberg, 2008, p194). The genogram also offers the family a way of understanding the therapeutic exploratory process in a way that is not highly emotive (ibid).

By including his family in the therapy various other interactional patterns could be presented in a multi-generational context to explore how the family maintains alcohol as the problem (Corey, 2005, p. 450). Working systemically provides the therapist with more than one perspective, allowing the therapist to track interactions and to facilitate changes in the way the family communicates and interacts with each other. According to Satir, by offering the family a nurturing context in which they can gain new learning, new patterns of behaviour can emerge (Corey, 2005, pp. 83-185) and Stan can begin to experience meaningful and fulfilling relationships such as he desires without having to rely on alcohol to facilitate them.

PART B- SOCIAL CONSTRUCTION THERAPIES

Social constructionism has brought about a therapeutic perspective where truth and reality are viewed as being subjectively bound by history and context as opposed to objective, irrefutable facts (Corey, 2005, p. 385). In postmodern thinking there has been a shift from experts assigning meaning to an individuals experience to a more collaborative approach where the client is considered the expert and therapists the consultants (ibid).

Social constructionists challenge conventional knowledge, they encourage suspicion of assumptions of reality, they assert that language and concepts used to form meaning are historically and culturally specific, and that what we consider to be truth is constructed through social processes (Corey, 2005, p. 386). This section will outline two modalities of social construction therapies and then apply them to the case study of Stan. Solution Focused Brief Therapy

Steve de Shazer was an American Social Worker, Psychotherapist and author who along with his wife, Korean born Social Worker and Psychotherapist Insoo Kim Berg, founded the Brief Family Therapy Center in Milwaukee in 1978 (Simon, p. 27. 2010). Solution Focused Brief Therapy (SFBT) differs from traditional psychotherapy where the therapist’s focus is on problem formation and problem resolution. Instead, SFBT focuses on client strengths and internal resources by exploring previous solutions and exceptions to the problem, and then, through a series of interventions, encourages clients to do more of those behaviours (Macdonald, 2007, p. ). Therapists allow clients to determine the goals of therapy and assume a respectful, cooperative stance where interventions are delivered within the client’s context of understanding, often in the client’s own language or phrases (Macdonald, 2007, pp. 7-8). Whilst a set number of sessions are not necessarily contracted at the outset of therapy, therapists will usually see clients an average of three times with the principle of minimal intervention reducing the need for extensive histories to be gained by the therapists or in depth explanations of the difficulties to be offered (O’Connell, 2005, p19).

SFBT is a future-focused, goal-directed approach that uses questions designed to identify exceptions, or times when the problem doesn’t occur, solutions and scales to measure where the client currently is in relation to their goal and discover behaviours needed achieve further progress towards their goals (Corey, 2005, p394). Miracle questions are used to encourage clients to dream, as a way of finding out what they most want and providing a description of life without the problem (ibid). SFBT also uses homework, pre-therapy change exploration, compliments and bridging to elicit change (ibid).

Narrative Therapy Michael White was an Australian Social Worker, author and Psychotherapist who developed Narrative Therapy with his colleague, New Zealand Social Worker and Psychotherapist David Epston (Piercy, Sprenkle & Wetchler, 1996, p133). White and Epston believed that individuals form meanings of life through interpretive and often negative dominant stories that are treated as absolute truths and internalized. They referred to this as a problem saturation, which doesn’t allow people to see the times when they don’t have the problem or their dominant story (ibid).

A Narrative approach will externalise the problem to allow a person to challenge its influence on their lives and re-write their story with a richer alternative narrative (ibid). Narrative therapists will adopt a collaborative approach to assist the client to form a name for the problem, explore how the problem has been impacting the client, discover times when the problem hasn’t been present or occurring and encourage the client to find alternative meanings and stories with new language and perspectives (Corey, 2005, p. 398-399).

The narrative approach emphasises the importance of optimism, respect, curiosity, persistence and valuing the client’s knowledge (ibid). Techniques that are used by therapists include externalization, deconstruction, searching for unique outcomes, creating alternative stories and re-authoring, providing an audience to the changes the client is making through encouraging clients to share their successes with others, writing letters to the clients and jointly writing case notes with the clients to lesson the power differential between therapists and clients (Piercy et al, 1996 p. 33-134). Working with Stan from a Social Construction Perspective In working with Stan from a social construction approach, the therapist would assume that Stan is the expert on his life and that the therapist’s role is as a collaborative consultant (Corey, 2005, p. 504). Stan has already identified his goals to be having more people in his life, finding a career where he can make a difference to others, feel equal to others, and find more helpful ways of coping (Corey, 2005, p. 14).

The therapist would assist Stan to further define these goals and explores skills that he already possesses to assist him to achieve these goals. Combining a narrative and solution focused approach, the therapist would empower Stan to draw on his internal resources to make the changes he desires and achieve the goals he has identified rather than seeking to understand the source or history of his problems (Corey, 2005, p. 504). The value of working this way is that alcohol and Stan’s fear of relationships are externalized and he is offered the opportunity to re-author the story of his life.

Using a social constructionist approach, a therapist would focus on Stan’s strengths, explore the exceptions and encourage Stan to harness these skills so that he can experience more of the positive outcomes he has achieved at these times (Macdonald, 2007, p. 1). Stan’s identified determination, ‘guts to leave his shady past behind’ and acceptance into college would be hi-lighted and the times that he has successfully worked with young people at youth camps would be explored as an exception (Corey, 2005, pp. 12-13). Stan would be encouraged to utilise these solutions in other areas of his life where he feels defined by his problems.

Stan has previously experienced the benefits of having his strengths witnessed by an audience and described his youth camp supervisor’s confidence in him as a “major turning point” (Corey, 2005, p. 13). To further this experience a therapist could encourage Stan to identify people such as family members, his peers or perhaps his supervisor to become ‘outsider witnesses’ and at an appropriate stage of therapy these witnesses would be invited in to hear Stan’s revised and re-authored life narrative (Payne, 2006, p. 16).

In conclusion, by undertaking a review of a variety of both systemic and social construction therapies and then applying both ways of working to the case study of Stan provides clarity around the effectiveness of both approaches when working with either an individual or a family. It would seem that using an integrated methodology has much to offer both the client and the practitioner in meeting the particular needs of families and individuals presenting for therapy. REFERENCE LIST Adler, A. (1929) The Science of Living. George Allen & Unwin: London Boeree, J. (2006) Personality Theories.

Alfred Adler [Online], Available: http://webspace. ship. edu/cgboer/adler. html Accessed 16/08/2010 at 6. 15pm Bowen, M (1978) Family Therapy in Clinical Practice. Aronson: New Jersey Bowen, M. (1994) Family Therapy in Clinical Practice. Aronson: New York Brown, J. (2007) Going Home Again: A family of origin approach to individual therapy. Psychotherapy in Australia, Vol. 14:1, 12-18 Corey, G. (2005) Student Manual for Theory and Practice of Counselling and Psychotherapy 7th ed. Brooks/Cole Thompson: California Goldenberg, I & Goldenberg, H. (2008) Family Therapy: An Overview.

Thomson Brooks/Cole: California James, K & MacKinnon, K. (1986) Theory and Practice of Structural Family Therapy: Illustration and Critique. Australian and New Zealand Journal of Family Therapy, Vol. 7:4, 223-233 Jordan, K. (2008) The Quick Theory Reference Guide: A Resource of Expert and Novice Mental Health Professionals. Nova Science Publishers: New York Kerr, M & Bowen M. (1988) Family Evaluation. Norton & Co: New York O’Connell, B. (2005) Solution-Focused Therapy. Sage Publications: London Payne, M. (2006) Narrative Therapy: an introduction for counsellors. Sage Publications: London

Piercy, F, Sprenkle, D & Wetchler, J. (1996) Family Therapy Sourcebook. The Guildford Press: New York Sherman, R & Dinkmeyer, D. (1987) Systems of Family Therapy: an Adlerian Integration. Brunner-Routledge: New York Sholevar, G & Schwoeri, L. (2003) Textbook of family and couples therapy: clinical applications. American Psychiatric Publishing Inc: Virginia Simon, J. (2010) Solution Focused Practice in End-of-Life Counseling. Springer Publishing: New York Sweeny, T. (1989) Adlerian Counseling. A Practical Approach for a New Decade (3rd ed. ). Accelerated Development: Muncie, IN.