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Thanks to Ayelet Kahane

Family as a System – class notes 2008-9

11/10/08

HaMishpacha KiMa’arechet

Position is key in family therapy. For example, if one spouse opposes the second spouse on a certain issue, the therapist has to make spouse 1 see the position of spouse two, and vice versa.


Individual therapy can be conducted in many different manners. Each approach is effective, despite the fact that they are all different from one another.

  1. The Psychodynamic Approach:
    1. Explores the dynamics between the different components within man’s personality: the Id, Ego, and Superego.
    2. This approach is more concerned with man himself, and less so with surroundings, and his interactions with his surroundings.
    3. It is a process that deals with understanding the inner psychological conflicts of man, through man’s impulses.
    4. This approach tries to explain the defense mechanism, the mechanism where man contradicts reality, in order to defend himself. For example, if he broke something, and someone said to him, “why did you break this?” he would answer, “what! It wasn’t me!” The defense mechanism helps man deal with certain frustrations.
    5. All in all, this approach attempts to discern that which is happening within the nefesh of man.

  1. The Behavioral Approach:
    1. Stimuli ** Reaction
    2. If a positive response ensues, man will strengthen that reaction, and if a negative response ensues, man will weaken that reaction. Chizuk Ha’limidah.
    3. For example: a warm and bright face, or a smile, or certain body language = reinforcements of a certain reaction.
    4. Extreme example: Electric shock Autistic children every time they try harming themselves. In this manner, they learn not to hurt themselves because they want to avoid the unpleasant electric shock, which acts as a negative response every time they react a certain way.
    5. Another example: A fly was found in Joe’s McDonald’s salad. Because he now associates dead flies and McDonald’s, he can no longer eat there. Man draws very close associations.
    6. This approach works to cope with fear, through a gradual exposure and then understanding of that fear.

  1. The Cognitive Approach:
    1. An outgrowth of the Behavioral Approach.
    2. This approach is founded upon the following idea from the Greek-Roman philosopher Epictatus, who said, “there are no happy events in life, and there are no sad events in life. Life is full of situations and events, and what makes pleasures or tribulations is OUR INTERPRETATION of those situations and events.”
    3. So there is a stimulus, and that causes a reaction, but in between the stimuli and the reaction there is man and his memories and attention in the psychological, as well as physical realms.
    4. A reason for the fact that different people react differently to the same stimuli is because each individual is also taking into account all that he has heard and all that he remembers. In other words, man’s reactions can only be understood in context of man’s life experience.
    5. The Cognitive Approach seeks to connect and build and explanation

* CBT = Cognitive Behavioral Theory. The fusion of the two theories explains that there is a stimulus and a reaction, and that reaction involves tremendous individualistic interpretation on the part of man.

  1. The Humanistic Approach:
    1. There are people who incessantly bemoan life. They see their lives as jails.
    2. Victor Frankel, Rogers, and Maslow devised an approach for those kinda of people.
    3. They believed that man is born good hearted, and it is only life circumstances that ruddy that natural state of good. (This is unlike Freud, who believed that man is born with a bad heart, and therefore needs to learn to bridle it.)
    4. They believed: man needs to find MEANING in his life because without meaning, he has nothing to live for.
    5. For example: Victor Frankel survived the Holocaust because he trained himself to believe that every moment that he continued to survive, he was taking revenge on the Nazis. With this meaning, he had the drive to continue fighting for his survival.
    6. Based on Niche, who said, “One who has WHAT to live for, knows how to accomplish ANYTHING.” Mi she’yaish lo MA she’limaano yichyeh, yadah limtzoh kol AICH.
    7. Meaning is the fuel to life. It allows man to find a way to accomplish anything.
    8. One of the main goals in therapy is to determine WHAT man wants. Once man knows what he wants he can accomplish exactly that. Obstacles are what man sees when he loses sight of the goal.
    9. Frankel explains that there are certain things that man must do, in order to reveal his goal:
      1. Self-revelation:
        1. What are my strengths and what are my weaknesses?
        2. A run through my memory: where did I succeed and where did I fail?
      2. The reality of my uniqueness:
        1. What makes me uniquely me?
      3. Choice:
        1. Free choice is a fundamental stipulation to a quality life.
        2. You chose between two different options. Nothing is ever black and white. You always need to create an alternative, and understand that situations and goals are always changing.
      4. Taking of responsibility:
        1. I need to take responsibility for the choices that I make.
        2. A person who takes responsibility does not fear failure, but rather examines WHAT caused him to fail, what did not work, and vice versa.
      5. Going beyond myself:
        1. Looking beyond myself. It’s not just about what I can get out of a situation.
        2. Giving is reciprocal, so one who helps others is also improving the quality of his life.
        3. Once I determine my strengths, I have to think what I can do for others with those strengths.

11/17/08

  1. Geshtalt Approach
    1. People fit into certain molds, certain schema.
    2. What’s important is the now. We relate to the past, in order to understand the present. Oftentimes people react a certain way in the present because of unresolved issues in their past. This approach seeks to liberate the person of their past unfinished business.
    3. This approach involves a purifying process through various techniques.
    4. For example: Take a chair, and personify that chair, as the source, or a source that is causing the patient trouble. For example, the chair is the patient’s mother. Now the person is going to have to express all their anger and pain to the chair. The therapist, then, focuses in on what the points of contention are, and interferes there, in order to revamp the patient’s perspective to a more positive one.

What is a family?

A family is a community established based on time and place. The community is dependent upon a certain communal order, and the need and desire to be organized in groups.

The need to belong is a strong desire in man.

The community establishes certain rules. That communal order that is established creates certain clarity and understanding for the individuals. No one is a jellyfish. Everyone has rules. It is just about how rigid or flexible those rules are.

Very strict rules can be accompanied with fear and problems. For example, if a child is educated with very strict rules, it demonstrates a lack of confidence in the child, and therefore the need to place a “bridle” on him/her. This can then cause a lack of confidence within the child.

On the other hand, those community rules are threatened when the definition of family is different. For example, when there are polygamy or homosexual relationships.

David Elkind:


11/24/08

What is the purpose of the family?


Maslow: There is a hierarchy of man’s needs. These categories build upon each other. It is a pyramid, and one can only get to the next category by accomplishing the last.


Concepts of the Post-Modern Family:


We need to know what is necessary for the existence of the family, and what is lacking in each particular case that we confront. The big Q we always ask is…למה? What is lacking here?

We need to find the balance between integration and differentiation, the balance between being a part of a certain form in a certain family/community, and still being one’s own person, one’s own individual.

גישה המערכות:

The form of the individual:


12.1.08

Every מערכת needs a purpose. If you don’t have the “what,” then you won’t have the “how.”

Every system is complex with subsystems. We, as social workers, need to examine the different parts of the whole.

Each subsystem has strong reciprocal ties to the other subsystems that are dependent upon reciprocity. Each system has boundaries – physical and psychological. Each family creates its own boundaries.

עבירות = Breached boundaries, anything goes, everything is ok – VS – Boundaries that are very rigid and have no flexibility.

Oftentimes there are breaches on boundaries within a family, between the inter-generational framework.

The system aspires for balance.

One needs to remember that any input that enters the family does not exit unchanged, rather it undergoes a process of change within the family framework, within that system.

Families are constantly undergoing change, and therefore are always striving to attain a sense of balance.

Salvador Minuchi: The family needs to always be open in order to adjust to its surroundings.

The stops in the family’s lifespan:

  1. Finding a spouse
  2. The birth of the firstborn
  3. The child goes to gan
  4. The child becomes independent
  5. The child leaves the home ** army, marriage, university
  6. The “empty nest”
  7. One spouse retires
  8. Both are retired and living off pensions ** are they capable of being together all the time?
  9. One spouse dies

Homeostasis (nothing changes) ---- The Equally Balanced Dynamic ---- Always changing


12/8/08

  1. Couple Coalition: After establishing their connection, the coalition is no longer just a couple, but rather becomes married.
  2. Parental Coalition: Everything changes from the couple coalition because now the couple is focusing their energy on satisfying the needs of the child.
    1. The challenges of a parent are far from simple, and one needs great support when going from one stage within the lifespan to the next.
    2. The principle of reciprocity is very important within a family.
    3. Divorce can affect a child in the following ways:
      1. No change.
      2. The child can start acting up, acting in a disruptive, unconventional way.
      3. The child has a lack of concentration and participation.
      4. Suddenly is wonderful and volunteers.
      5. Need to look for change. A dramatic change can point to the difficulty and hardship that the child is suffering, and the defense mechanisms he is using.
      6. For example, if a child’s behavior does not change, it could point to the child’s denial of the divorce.
      7. Especially in the case where the divorce is ugly (although it depends on the age), it can really affect the child’s sexual identity. This can manifest itself anywhere from being homosexual to being confused about his/her identity and the gender roles that come along with that. The understanding is that when things are normative with a child’s parents, the child does not have difficulty understanding and forming his/her sexual identity.


How do we find balance? How do we adjust?

Miriam Golan:

  1. One needs to know how to separate and differentiate between each stage of life. It is a cognitive process. One needs to think, understand, and accept their current reality, their new reality, the advantages to it, as well as the disadvantages. This is the fundamental condition to successfully adjusting.
  2. To learn to new roles, which come along with the new status.
  3. To plan for the future. One needs to have strategic thought. Find a goal and a way of reaching it. קתע = קבלה תפקידים עתיד. Man cannot expect everything that he will experience, however. When man suffers sickness, loss, etc., it can very easily destroy his emotional stability.
    1. Signal Fear = indicates that which is to come ** What will happen if… ** This fear helps man prepare for life situations ** This preparedness and alertness helps man to react in a higher manner during stressful times ** For example, this allows us to be responsible about money, or study for a test.

Interaction within the family = For example, the father is thanked for giving something to his kids, and this recognition of gratitude causes the father to continue to give and to give even more. Another example is one where the father gets angry with the child, and so the child knows that whatever he did, it is forbidden.

    1. Positive and negative strengthening of actions.

Unburdening = The situation where man unloads his baggage on other people.

    1. Unburdening in therapy = the situation where the patient transfers significance from an object, generally with meaning, to the therapist.
    2. Negative unburdening = the therapist unloads his baggage on the patient.
    3. Unburdening within the family = A husband unloads all his emotions towards his wife on his mother
    4. Unburdening negative complaints = The husband is angry and therefore promises himself not to become angry ** The wife then becomes angry, in his place (?)
    5. Integrated pathology = the father dies in war, and the wife does not cry because she believes that she must be strong for her child

.

12/15/08

העברה = Transference


Genogram = a pictorial display of a person's family relationships and medical history. It goes beyond a traditional family tree by allowing the user to visualize hereditary patterns and psychological factors that punctuate relationships. It can be used to identify repetitive patterns of behavior and to recognize hereditary tendencies.


12/22/08

זוגיות

Couples strive to achieve the values organized by Maslow from the physical needs (security, a roof over your head) to the emotional needs (acceptance).

Erich Fromm:


Theorists agree that man can only enter a relationship when he is on a distinctly high level, once he has already established himself as an independent person, separating from his parents and achieving person individuality.

If man enters a relationship with a low self-image, the relationship will become difficult and complicated.

Schertz:

5 Levels of Couple’s Relationship:

  1. Paradox
    1. The lowest level
    2. The situation where member of the couple wants to completely merge with the other member. This situation is hazardous for two reasons: on the one hand, the member is entirely dependent upon the other member, and on the other hand, the member feels strangled because s/he never has alone time.

Freud:

The antiquated love theory was that Cupid shot a love arrow in the hearts of two people, and the rest was history…

There are 3 components that create a couple:

  1. A great/nice sensory stimulus
  2. Mutual answering of needs
  3. Time ** the relationship is dependent upon development over time

12/27/08

It’s important to know why man entered couplehood, in order to understand the problems that he is now confronting. Oftentimes there is a gap between man’s expectations of couplehood and his spouse to what reality itself is.

It’s not easy building togetherness. The energy that the individual once used for him/herself alone now must be invested in someone else, as well.

Imbalances are caused all the time ** some are expected, such as having children, while others are unexpected, such as illnesses

How do we adjust?

Acceptance. Learning of Roles. Evaluating for the Future. (Ketah)

Spouses need to build togetherness, while simultaneously maintaining their individuality.

Spouses need to find the time to find the right dosages of things, in order to find an order of preferences.

Time:


It’s very important to define the boundaries and the quality of relationships with people – family members, friends – in a renewed fashion.

Meaning, there are things that were once good for the spouse, and with time have changed and are no longer good or appropriate. In such a situation, the couple has to re-evaluate their boundaries and what they need to do, etc.

Bergman:


In the first stage of building a couple, the couple tries to find:

  1. The balance between weaknesses and strengths ** who dominates in what?
  2. The balance between force and voluntary ** what do I do because I am required to do, and what do I do because I want to do it?

Defining the Jobs:


Three Categories of Roles:

  1. Symmetrical = the spouses do the same things
    1. Positive: It is efficient because if one spouse can’t do something or be somewhere, the other one could fill in.
    2. Negative: Fosters tremendous criticism between the two.
  2. Complementary = each spouse has his/her specific roles, and it is forbidden to cross those boundaries
  3. Parallel = there are roles that only the woman fills and roles that only the man fills, but there are also roles that are interchangeable
    1. Generally considered the ideal model

“Gil HaMa’avar:” There is a trend where the roles shift. The woman comes to a point that because her life situation has changed (children have grown up, does not work anymore, etc.) she wants to go out of the house, learn, do different and new things, etc. The man, on the other hand, wants to finally rest, after having worked so hard for the past 20/30 years, etc.

Other reasons people marry…

Miriam Dishon-Berkovitch:

What is the best foundation for a couple to have?


Scarf:


Problematic reasons to marry:


1/5/09

When we are trying to characterize a problem, one attempt is to first determine what the different roles are within the couple and how they divvy up the jobs.

Virginia Satir:


Only until very recently, Muslim families would marry within the family. Now, that science has determined the genetic dangers involved in marrying within the family, has this practice decreased.

Myths about love:

Despite the cognitive approach, many difficult situations emerge from faulty thoughts or expectations, regarding relationships.


Partner Patterns:

Need to identify what kind of couple the couple you are giving therapy to is, in order to then understand and identify their problems.


Monica Maigodrick:


Communication:

Olsen:


Non-Verbal Messages:


Intonation = the tone and way that things are said

We need to make sure that our body language and our intonations are congruent.

To tune in = to really enter the patient’s frame of reference

What is communication?

  1. A process of receiving and giving information ** the straight line model
  2. A process that involves feedback, as well ** the cyclical model
  3. Solomon:
  4. Virginia Satir: Therapists need to convey messages crystal clear
  5. Dans: Communication should be spiral, with no end to it. The messages we communicate are very much affected by the way and the timing we chose to convey the message.

Meta-communication = the messages that are conveyed beyond the concrete message itself

There needs to be “kesher kaful” = ?

Satir:


Moss:


Families also have myths. They hold on to these myths because if the myth is dispelled or revealed, the family will fall apart. We only dispel or reveal this myth if there is a definite need to.

Satir:

Every family has different patterns of communication, and each pattern has a different defense mechanism:

  1. Guilty pattern ** his defense mechanism = projects his problems on others
  2. Rational pattern ** he uses his intellect, rather than getting in touch with his inner feelings
  3. Bridging pattern ** afraid of conflict, and therefore ignores conflicts and problems
  4. Blurring pattern ** he runs away from problems by pushing them out of sight and mind, using denial and suppression
  5. Balanced pattern ** someone who is balanced ** he figures out when to use more emotion or more intellect or whatever is appropriate for the situation ** he evaluates the consequences ** he is aware of all this so it is not really a defense mechanism

Barren:

Three patterns in communication:

  1. The child ** the Id principle = self-centered, cannot wait, etc.
  2. The parent ** authoritative, responsible
  3. The boger ** thinks things through, struggling with all the options, very thought-through

Social workers are always switching communication hats, but have to constantly be evaluating if their communication is appropriate for the situation.

Alberto and Amonus:

Assertive communication:


Three conditions for a healthy family:

  1. A strong coalition between the couple ** togetherness, intimacy and autonomy ** when the couple is strong, the family can develop
  2. The division of jobs between the sexes
  3. A clear hierarchy between the generations

Satir:

A parent has 3 roles:

1) Protector of the child’s security

2) The leader and educator

3) The friend

Speigal:


Bergman:


Speigal:


How do we confront conflicts?


Sometimes one of the sides will try and form a coalition with the therapist. It is therefore integral that therapists be wary of this and put all their efforts into remaining neutral.


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