Fundamental Theories in Marital and Family Therapy

September 12, 2011 – Joan Keefler

What is a theory:

-explain facts and laws. Popper: theory should be open to trial-and-error falsification. Fallibilism: the stronger the idea is those who survive criticism and refutation. 

Confirmation bias: asking the questions which fit your original hypothesis. You can miss important info!!!! 

Reflexivity: impact of own beliefs on the client system:

   “hypothesis”

   “theory”

   “fact”

   “law” 

      observations or inferences about the natural world that have been repeatedly confirmed to the point that they are accepted as “true”

 

  

 

 

 

 

  Shields (1986)

 

 

      “ The Science which deals with the origin and method of knowledge”

    Concise English Dictionary 

     Shields (1986)

      ASK FOR EXAMPLES

 

 

Keeney:  ecosystemic epistemology

 

NOTE: Epistemology is the active process of correlating theoretical constructs with data derived  through sense experience.

     Shields (1986)

 

      Describe the situation that acted as a catalyst for the development of the theory

 

 

 

 

      Theory written in such a way that it invites the clinician to adopt its approach and lures the researcher to test it.

 

   

 

September 19th, 2011 – Abdelghabi Barris

Model: where you go – what you see: context, perspective

Concepts – abstract construct/representation 
 

Cultural changes in the last 50 years:

  1. Reforms in divorce law
  2. Increase in liberal sexual expression
  3. Increase in use of contraceptives
  4. Increase of economic and political power of women – can’t revert to the past!
 
 

Marriage was about procreation in the past or economic viability. Nowadays, it is seen as a source of adult intimacy, companionship and personal growth. 

Fundamental Concepts in Marital and Family Therapy 
Sept 2011-Session 2-

A framework for the study of Couple Therapy

Abdelghani Barris, MD and MA.

Argyle Institute

A-Three foundational points

Why couple therapy is important

Cultural changes in the last 50 years. 
*Reforms in divorce law (no-fault divorce). 
*More liberals in sexual expression. 
*Availability and increase of contraception. 
*Increase of economic and political power of women

Marriage: 
*Is no more about procreation or economic viability. 
*Is expected to be the primary source of adult intimacy, support and companionship and a context for personal growth.

Why couples seek Therapy

Because of threats to the security and stability of their relationship.  
*Emotional disengagement. 
*Power struggles. 
*Problem-solving and communication difficulties. 
*Jealousy and extramarital involvements. 
*Values and roles conflicts. 
*Sexual dissatisfaction. 
*Abuse and Violence.

Common characteristics of Couple Therapy

Dominant attitudes and value systems of MFT that differentiate them from others are: 
*Clinical parsimony and efficiency. 
*Adoption of a developmental perspective on clinical problems, with attention to current problems. 
*Balanced awareness of clients’ strengths and weaknesses. 
*A de-emphasis on the centrality of treatment in patients’ lives.

Four central sets of technical factors that characterize couple (and brief) therapy.

1-The meaning of time (three ways) 
*Timing of the problems(why now?). 
*Timing of intervention (early) 
*Timing of termination (no much time to a “working through” phase of treatment.

2-A clear establishment of treatment focus as essential (Donovan, 1999 ), 
emphasis in the couple’s presenting problems.

3-Tendency to be eclectic if not integrative in techniques use. 
As the use of out-of-session “homework” tasks to provoque change in the natural context.

4-The therapist-patient relationship is seen as less pivotal to therapy’s outcome than Indiv therapy. 
The central healing relationship is the couple’s one.

B-Background of the approach

A four phase history of Couple therapy 
*The first phase:(1930-60) atheoretical marriage counseling formation. 
(Advise giving and guidance about adaptive  family and marital roles and values)

*The second phase (1960-1965) 
called “psychoanalytic experimentation” from beginning until mid-sixties.

*The third phase: (1965-1985)  
“Family therapy incorporation phase” and golden age of FMT.

Four important figures of  CT: (during this phase)

*Don D Jackson (1965): the linking of the systemic dimensions of the couple with the individual self-definition and self-concept of the partners.

*V. Satir (1964): emphasized both skills and connection. (Nichols 1987: the self in the system)

*M. Bowen (1978): addressed intergenerational matters systematically with couples.

*J. Haley (1963): the central metaphor of marriage involved Power and Control. (who is to tell whom what to do under what circumstances)

*The fourth phase: (1986-)the renewal  
Mature phase and further differentiation from FT. (especially North-America)

The three phase History of Research in Couple Therapy

*The first phase: (1930-1974) 
a technique in search of data. Publications mostly descriptive and self-reporting of clinical experiences with couples.

*The second phase (1975-1992) 
earliest comprehensive reviews of empirical research on the outcomes of couple therapy.

*Third phase (1993-present) 
period of “Caution and extension” 
attention to a wide variety of more sophisticated and clinically relevant questions about CT. 
Questions like:

*How powerful is CT? 
*How durable are the effects of change from CT? 
*What is the efficacy and effectiveness of different models of CT? 
*What factors (therapist and couple’s) predict responsiveness to treatment?

Four profound shifts

First Shift in CT: 
The re-inclusion of the individual 
(psychology of the self, Object relations Psychology, attachment theory etc..)

Second shift: 
greater acknowledgment of the reality of psychiatric/psychological disorders, and such problems are not reducible at systemic level analysis.

Third shift: 
in the last 2 decades, the CT field growth was mostly fueled not by the FT field, but from psychological inquiry of social learning theory, psychodynamic theory, humanistic-experiential theory.

Fourth shift: 
CT has emerged as one of the most vibrant forces in the entire domain of FT and of psychotherapy in general.  
 

October 3, 2011

2 central matters in Couples Therapy:

  1. Who participates?
  2. How long and how often?
 

-couples therapy started in the world of psychoanalysis [individual]

-some approaches suggest 1 x a week frequency. Others give other time frames. 

Therapy about the couple [i.e. individual therapy, or one of the couple members not ‘jumping’ into therapy] is not the same thing as therapy of the couple. 

-couple therapy is usually brief –  nowadays, average is 17-18 sessions. 

Role of therapist?

 

Norcross and Prochaska [1993]: we bring ourselves first: clinical experience, personal values, philosophy, life experiences. 

Gender of therapists: also influencing the therapeutic setting.

Cognitive, affect, actions: three components of a person in the clinical setting – x how many people in the room. 

3 categories of closeness-distance categories of couples therapy

  1. Coach/educator – experts – imparts knowledge
  2. Perturbator – from outside w/o giving info – provoke the system
  3. As healer – special emphasis on relationship in treatment – second order cybernetics
 

Cybernetics of the first order –  outside the system

Cybernetics of the second order –  counsellor enters inside the system – and can observe himself from the inside 

October 17th, 2011

CHANGE PROCESSES IN COUPLE THERAPY: ANINTENSIVE CASE ANALYSIS OF ONE COUPLE USINGA COMMON FACTORS LENS – blow et al. Main point of article: so many different elements to change.

Interesting factors: therapist held the hope, normalization; external factors may make a huge influence on outcomes; importance of the alliance. Reframing, quality of the relationship. Client motivational factors.

 
 

One study shows factors include: 30% therapist. 40% external factors 

October 24, 2011

Family has:

  1. Structure
  2. Patterns = organization
  3. Dynamics  = organization
 

Systemic thought is interactional in nature, vs. The psychodynamic [linear] cases 

First order cybernetics: feedback loops – what message supports the symptom and what does the symptom relay?

Second order cybernetics: added subjectivity to the feedback loop perspectives 

-family systems are seen as greater than the sum of its parts. But only if they work well together. If they work in hindering ways, the system is lesser than the sum than its parts. A random collection is the sum of its parts. 

Family has strategies, rules, roles, legacies, heritage, beliefs, etc... 

Primary socialization = family

Secondary socialization = peers, school-peers – i.e. things outside the family – extrafamilial context. 

Elements of a system

Biological-psychological-social-cultural-economic-spiritual 
 

-idea: work with the person who called: this is the person most pressured or wanting of change 

October 31, 2011

Concepts: cybernetics first and second order. IP – identified patient: symptom bearer. 
 

Cybernetics: feedback loop. First order: objective reality that is to be discovered by a therapist outside the system – more directive from the outside. Second order: looking at the subjective elements of the feedback loops – the therapist is not an objective observer but the feedback of the system informs the therapist – Constructivism – joining/internal process based.

Linear causality: attending to the content. Pointless! Getting more information will not get the relational pattern

Circular causality: how each person’s position is holding the other’s positions which the first is reacting to. One must thus look at the cybernetic transactions . one can look at feedback loops in interactions between more than 2 people! Circular causality shows you the connected to each other’s behaviours. Participant-observer. 

One can do serious damage by going for the symptom as it often negates the underlying issues. You may collude with the underlying issues. 

-the role of the therapist is different, according to which model/outlook he has. 

November 7th, 2011

Life-cycle stages

  1. Early stages
    1. Coupling
    2. Becoming three
  2. Middle stages
    1. Entrance
    2. expansion
    3. exit – first to last child leaving home
  3. later stages
    1. becoming smaller – empty nest
    2. endings – retirement to death

-contrast the above with unexpected events

or

  1. married couple without kids
  2. Child-rearing
  3. Preschoolers
  4. Children
  5. Teenagers
  6. Launching
  7. Middle-aged parents – empty nest
  8. Aging – retirement to death
 

Stressors:

  1. Transition from couple to parents
  2. One to two children
 

-those stressors are pretty hard and could in some cases even lead to breakups due to the stress being intolerable. 

Vertical stressors: ongoing family stressors

Horizontal stressors: intergenerational stressors

Unpredictable stressors: death, accidents 

-Individual is affected by the family who is affected by the community 

-three life-cycles intersect: individual, couple and family  

November 14th, 2011 -gender and family 

-sex – biological, gender is social/cultural. Often, gender/sex is assigned roles in the family 

-important question for family therapists: how does the family rules, roles, legacies, dynamics, etc. Influence the person/family. What we bring into the therapy as a therapist will influence your interventions, including in the gender realm. It could also influence your sense and ideas of agency. 

-in the past, men historically had more social power. This was also felt in the theorist gender make-up of the therapy professional. 

Power and control: women had her body  

-culture and ethnicity [origin] also influence the therapy, both as therapists and as clients. So does social class 

November 21, 2011

-in the 80-90s, counter-transference was accepted into the systemic thought. Before that, it was rejected as a psychodynamic term. 

Family as a psychosocial system

-homeostatic, mechanistic. Has feedback loops. Those concepts came from biology. 

The systemic thinking was revolutionary as it was not depth psychology, it was not intrapsychic. The systemic thinkers realized that schizophrenic relapsed during the return home. When Bowen worked with families, no one knew about it. Psychiatrists still see schizophrenia as biological. People developed family work independently, i.e. Murray Bowen, Harry Stack Sullivan, Palo Alto group – all working alone 

Homeostasis – form does not move. Morphostasis – movement in the form/structure 

-there are repeated patterns within a system

-circular causality -A influenced B who will influence C who will influence A. 

Closed [no change, homeostatic] vs. Open system [morphostatic]. 

Jay Haley – began questioning whether the therapist is supposed to promote stability. Change is also important. Some family members opt to leave the family system when there is no safe space to express something within the context of the family. Acting out takes the place of overt expression, even though the action may not be overtly conscious. 

Third cybernetics: looking at the observer of the observer. 

Symptom: may be an indicator of an inflexible and restrictive rule. Function: Symptom may try to shake the system [i.e. to organize a family meeting], maintain homeostasis, etc.... Symptom may be an inadequate solution to a problem – strategies do not work anymore for the issue at hand. Symptom expresses the problem for the family. Crisis: when coping mechanisms are inadequate to the issues at hand. Symptoms are often attempts to resolve paradoxes. 

Meta-rules – rules about the rules: how the rules are supposed to be dealt with, how they are meant to be changed, if at all allowed to. There are some explicit and implicit rules.  

Roles: what each does in the system –functions. Rules = process 

Symptom is also a vulnerability and also strengths. 

November 28th, 2011

Strategic [Bowen] and structural [Minuchin] are both first order cybernetics. 

-clinical eclecticism is dangerous because you have to apply tools from the same cluster of therapists – the tools must fit the roadmap, so mixing and matching may not be appropriate if the clinical maps and tools are divergent. 

Second-order cybernetics:  especially the social constructivists –look at narratives/discourses are important – how people describe their situations and objects in them. Problems do not have a function, but the interaction creates the problem. Language is part of the second-order. Internalizations are also looked at it. Second order therapists will not coach but discuss – places themselves as non-experts. First Order cybernetic people, i.e. Minuchin, Bowen, saw themselves as experts. 

Positivistic [the therapist has a model of how a family paradigm should be] -vs. Post-positivism [constructing what works]  

Systemic thinking: families evolve: today’s solution may be tomorrow’s problems. 

Dec 5-12, 2011 

         

 

 

      An individual’s work and education is an essential source of data, not only to socioeconomic status but also to the client’s functioning and self-concept.

      Nature and motive for service request

      Person or persons making request for service

 

      All sources of information, an estimate of their credibility and the context in which that information is gathered

 

 

 

      Description of the problem and/or needs from the perspective of each member of the family, in their own words

NOTE:  This process can take the entire first interview with a family

  

      Includes the history and antecedents to the problem,  predisposing factors and precipitating events.  Any differences in each member’s perspective should be noted

      An estimate of the disruption in the  family’s functioning   and degree of distress of each member

      The geographical location of the problem – any differences in each member’s perspective should be noted.

 

 

      Any current factors that contribute to the perpetuation of problem;  cultural,   environmental, life cycle, discrimination or systemic variables related to the problem.

      This component would include any current factors, excluding client characteristics, which contribute to the problem

 

      The scope of content could be very broad as it might include cultural, environmental, life cycle, or systemic variables including any evidence of discrimination that specifically related to the perpetuation of the problem.

      The priority each member and therapist gives to the solution of the problem

      This may be considered a generic variable as most clients present with several problems and some priorities must be established by both parties about the change potential of the problem.

NOTE:  A kind of MSE for family therapist.  The observations of the therapist 

      Includes the family’s strengths and coping skills according to the family and therapist

   Positive factors in the family’s relationships.

 

      Concrete resources, formal and informal,  needed to resolve family problem(s) and obstacles to their access.

 

 

--

 “the backbone of any profession’s claim to competence” (Mailick, 1991)

 

      “a time for reflection, enquiry and vigorous analysis.  Assessments encourage practitioners to stop and think about what is going on” 

 

      “…even more important is the likelihood that treatment itself would be more adequate and at times would move more rapidly if the interpretation of the worker benefited more often by the clarity and penetration which precise formulation in writing tends to develop. “(p. iii)

      client’s problems and the basis for intervention

 

  i.e.  The connection between the problem, the process of intervention and the result of family therapy treatment.

 

 

“A family (with one or two parents) consists of several people who live together, normally the two generations represented by the (real, adoptive, foster, or step) parents and the (real, adopted, foster, or step) children.  Life together in the family is characterized by joint tasks, the wish for intimacy and privacy and by the family’s utopia.  When a family is founded, each partner contributes his own personal notion of family utopia, which is realized as a life form and adapted to incorporate the partner’s ideas and social reality.  Thus a framework is created for the developmental and life tasks that are to be fulfilled by the family. “

 


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