I.

intro:
a. The myth of the hero: we are living in a society that romanticizes the hero. If
we dont become a hero we feel as "failure". This idea is just an illusion.
Another tendency is to be individuals that will thrive for "self-autonomous" in
an extremist way; that is, always seeking everything by ourselves; however, the
reality is that we all need all. Our past, our family and the community forms
who we are.
b. psychotherapeutic Sanctuary: Freud preferred the individual therapy because
he was interested in the "family-as-it was remembered" instead of the family as
now. Because the individual therapy was seeing as the optimal goal for healing,
soon, there would have been a discovery about the impact of family on one's
behavior. Carl Rogers' idea of self-actualization was always guiding us to fulfill
our needs when we dont follow our dreams, then we feel depressed and
anxious; that is, ignoring our needs and satisfy others' will take to experience
discomfort; therefore, he opted for "unconditional positive regard" listen to
support the clients in the process of discovering his or her needs.
c. family versus individual therapy: the idea that one's personality is shaped by us
from the individual therapist and they assist clients in facing their fears and
learn to focus to live more fully themselves. On the other hand, family therapist
focus on the external family (social theory) and how such interaction shapes'
one personality. The therapy framework is in changing the organization of the
family. The idea is that altering the entire family, there will a long and more
lasting effect. There are some problems that are better suit for family therapy
such as those related with children, complaints about a marriage or other
intimate relationship, family feud, and symptoms that develop in an individual at
the time of major family transition.
d. psychology and social context: family is more than multiple individuals
connected; it transcends this idea as the family is a whole system that interacts
and shares constantly.
e. Thinking in lines, thinking in circles: Instead of thinking that A causes B, family
therapist will invite the parent to think how he is influencing the child's
behavior; therefore, conforming a bidirectional effect.
f. the power of family counseling: the power of family counseling derives from
brining parents and children together to transform their interactions. It seems
that the power of family counseling comes from understanding each individual
selves and how these selves interact mutually; therefore, moving towards
creating a better way of interaction (communication, perhaps).
II. CHAPTER 1:
a. The undeclared war: A case study in which Salvador Minuchin treated a self-
mutilating man who was attached to mother and did not had a present-father.
Restoring the communication between them assisted the client to stop his
behaviors.
b. Small group dynamics: Group's dynamic process is applicable to family therapy
because of group life is a complex blend of individual personalities and
superordinate properties of the group. Gaining from theories and concepts into
family therapy:
i. From the research of Lewin, the "unfreezing" terms is used because it
is until the group unfreeze that changes began to happen. This can only
happen until facing unhappy experience.
ii. Wilfred Bion pointed out that some families get diverted from the real
problem engaging in patterns call "fight-fight, dependency and pairing".
That is, some family divagated around the issues, others use family
therapy to never contemplated compromise.
iii. Process/content: family therapist begin paying attention to how people
task as to the content of their discussions.
iv. Role theory: roles tend to be stereotyped in most groups and so there
are characteristic behaviors patterns of groups member. So, you may
have played a role expected from family
c. from groups, the atmosphere is positive, and dynamic, safe and comfortable;
this valuables from group dynamic is used in family therapy.
d. the child guidance movement: It was Freud the first of proponing to the
diagnosis of children disorders and agreed that issues of unresolved dilemmas in
childhood were the cause. Alfred Adler was the first one continuing with it and
established clinics in Vienna. The idea that neurosis issues of adults developed
in childhood continued while the cause (mother) was too analyzed and taken to
an extremist direction. It was John Bowlby's work that transition to family
work.
e. Research on family dynamics and the etiology of schizophrenia: Family therapy
emerging from schizophrenia etiology development.
i. Gregory Bateson: Started with the idea of communication and
metamessages that are sent from individual to individual (content and
hidden messsage). The idea that families when feeling threaten and
disturbed, it endevours to maintain stability or "homeostasis".
Therefore, if one of the members' behavior is different it may be calling
for stabilization.(if a kid acts out when the two parents are faigthing, it
may be due to the need of stability). This researcher along with others
came out with the idea of "double blind"; rather, two confusing
messages at the operational level and metacommunication level (teacher
angry because student don't participate, but when they ask questions,
teacher gets mad too). Therefore, schizophrenia is not only caused by
rooted inner self, but rather as an extension of schizophrenic families.
ii. Theodore Lidz: The problem: maternal rejection. According to Lidz the
father is the most destructive figure. He also pointed out that "role
reciprocity" is important rather than an individualistic fulfilling roles, it
is important to fullfill the other in a balanced manner. This lack of
marital unfulfillment reaches two types of marital discord:
1. marital mechanism: battle to get the child's love
2. Marital skew: one part of the marriage dominates the other
iii. Lyman Wynne:
1. pseudomutuality: there is no space for separate identities
2. Pseduohostility: it is a superficial split (separate identities)
iv. Role theorist: they focused on communication and family therapy started
from it.
f. Marriage in counseling: there is a different field of marriage in counseling and
family counseling (two fields)
g. The pioneers of family therapy:
i. Munichin and Haley
h. The golden age of family therapy: the flowering of the schools in 70s and 80s.
III. CHAPTER 2: Basic techniques o family therapy: from symptoms to system
a. Initial phase:
i. the initial telephone call: the goal is to an overview of the presenting
problems. Identify all members of the family and others that may be
involved. It is important to establish connection with the caller as basis
for encouragement. Motivate whole family to attend; however, if they
think that the one (son, husband, etc) with the problem should be only
the one with the problem be positive and respect. It is important to ask
how is the problem affecting the entire family. If the caller refuses to
have all in the family, insist that you would like to hear from all at least
in the initial meeting.
ii. the first interview:
1. the first interview is build up in alliance with the family and
develop a hypothesis of what the problem may be; keeping an
open mind to change and discard hypothesis.
2. The primary objectives:
a. establish report
b. introduce yourself
c. shake hands
d. conduct the family to the room
e. inform about the session and length of it
3. Keep in mind that family members may be nervous about the
process as they may have not experience therapy before and
they do not know what to expect... This can be aminorated by
asking "how do you feel by coming in today?".
4. Spend some time exploring family members interest,
accomplishments ad strengths.
5. IT is useful to get family history and genograms diagrams may be
useful too.
6. Two pieces of information that it is important: life chance or
"solutions that don't work" for current problem. Keep in mind
that it is more important to focus on the family strength is very
important for success in therapy.
7. There are times, although obvious, the family seeks help because
they have failed adapting or adjust to new circumstance of a life
change.
iii. the early phase of treatment:
1. Always seek for change. Now that strategy shifts from building
alliances to challenging actions and assumptions: pushing for
change. It does not matter what technique is used, therapeutic
alliances must be maintained always. It is important to
emphasize, at times therapist must be energetic to push for
change as it is not a simple perseverance.
2. Effective family therapy addresses interpersonal conflict, and the
first step in doing so is to bring it into the consultation room and
locate it between family members.
3. challenging assumptions or action may be good, but keep
listening, always!
iv. the middle phase of treatment: This middle phase the therapist may act
as mediator in which he or she sits and observe while keeping a healthy
conversation and intervening when the conversation is destructive while
allowing the family to use their very own resources (strength to solve
issues). It is important that the therapist remain calm by 1-knowing that
it is not his or her responsibility solving clients' problem and 2-knowing
that she or he can help looking up for constraints that may inhibit the
process. Respect client while working towards understanding , respect
shows them that you care, that they are capable for change, respect
means taking seriously the kid speaking, respect mean allowing clients
to face fears.
v. termination: usually comes after the family realizes that they have
achieved what they wanted. It is important to ask clients about possible
out coming challenging and how will they, perhaps, face them.
b. Family assessment:
i. the presenting problem: Families will walk into your room for consult
bombarding you with their "perceived problems" and seeking solutions
for their "helpless" situation. These stressful life situation makes for
their anxiety. 1-Exploring the presenting symptoms is the first step in
helping families move from a sense of helplessness to an awareness of
how by working together they can overcome their problems. When
families walk in, it is instantaneously that the therapist wants to help,
bur rather, one needs to hear the family's account. It is important that
each member of the family expresses their concerns. The goal of the
therapist is to move the family from a linear problem to an interactional
perspective; that is, from "it is John's hyperactive behavior" to "I truly
believe all of us are influencing John's behavior". Therefore, instead of
identifying who has the problem, therapist should work towards knowing
the "beliefs" of the members of "who has the problem". 2- identify the
attempts that the family has made towards solving the dilemma: what
have they tried? What have worked? what has not worked? This allow
room for further exploration. Therefore, searching for "who started"
the problem is rarely important.
ii. Understanding the referral route: who referred them? where they in
treatment before? what are the expectations? etc
1. identifying the systemic context: know the system: who is in the
family? Are there any person that influence this and who is
important to this family? any boyfriend living in? It may be
important to meet with teachers, counselor of the child how is
having trouble.
2. stage of the life cycle: find out if they are facing a life cycle
change: new home, new community, new friend, children growing
(developmental theories and expected changes).
3. Family structure: it is important who are the subsystems
(parents) and boundaries between them (children). For example
in some families parents will intrude in sibling disagreement nor
allowing the sister and brother to solve their problems. They also
fail to offer support for the child who feels bad.
4. communication: Many come for therapy complaining about
'communication issues' when in fact they want to change the
partner. Once communication is reestablished and they learn
how to listen to each other, they realize that there is no need for
change.
5. drug and alcohol abuse: Drugs are commonly used when
depressed or anxious. They are also associated with violence,
abuse, and accidents. Although, it may not be necessary to ask
everyone in the family about it; it is important to carefully
inquired about it. Some questions that may help:
a. do you feel you are a normal drinker?-->how many drinks
a day do you have?-->how often do you have more than
six drinks a day?-->does any one in your family worries
about your drinking?--> have drinking created any
problems?-->do you even drink before noon?
6. domestic violence and child abuse: if there is a suspicious of
abuse, neglecting behavior; therapist should inquired about it.
Be careful because the victims may not provide this info openly.
You must report; keep in mind that this may destroyed the work
alliance.
7. extramarital affairs: this may destroy the marriage.
8. gender: it is important to consider gender and expected roles of
gender in the family (cultural background).
9. culture: this can affect gender roles, values, costumes, etc.
c. Ethical dimension
i. family therapy with specific presenting problems
ii. marital violence
iii. sexual abuse of children
iv. working with managed care
IV. CHAPTER 3: The fundamental concepts of family therapy
a. cybernetics: the first study of families came from cybernetics and its feedback
mechanism in self-regulation system. and its "feedback look".
i. Feedback loop: the process by which a system gets the information
necessary to maintain a steady course. They way in which systems
within the look function impact the whole "feedback process". This
seems to point out to a communicative process. Therefore, if a behavior
is constantly appearing; perhaps, it is the feedback system that is
providing the basis for it.
1. Positive feedback: positive reward (reinforces the direction of a
system)
2. Negative feedback: it indicates that the system is straying off and
therefore corrections are needed to keep it in track. (therefore it
functions as negative-reinforcement in which the negative signal
provide a departure point to correct the error).
ii. Applied to families, cybernetics focused attention on: 1-family rules, which
govern the range of behavior a family can tolerate (family's homeostatic
range); 2-negative feedback mechanism that families use to enforce those rules
(guilt, punishment, symptoms); 3- sequences of family interaction round a
problem that characterize a system's reaction ot it (feedback loop)
1. self-fulfilled prophecy is a vicious cycle of positive feedback (one's
apprehension lead to actions that precipitate the feared situation which
in turn, justifies one's fears).
b. systems theory: A system-that is, an organized assemblage of parts forming a
complex whole. According to systems theory, the essential properties fo a
system arise form the relationships among the parts. These properties are lost
when the system is reduced to isolated elements. The whole is always greater
than the sum of its parts. Thus, from a systems perspective, it would make
little sense to try to understand a child's behavior by interviewing him without
the rest of his family. It taught us to see how people's lives are shaped by
their interchanges with those around the, .
i. general systems theory: From Bertalanffy:
1. a system as more than the sum of its parts
2. emphasis on interaction thin and among systems versus
reductionism
3. Human systems as ecological organism versus mechanism
4. Homeostatic reactivity versus spontaneous activity.
c. social constructionism: beliefs, and perceptions (a cognitive approach)
i. constructivism: Kant pointed out that knowledge as a product of the
way our imaginations are organized. According to George Kelly (1995-
first in applying constructivism to personal construct theory), "we make
sense of the world by creating our own constructs of the environment.
We interpret and organize events, and we make predictions that guide
our actions on the basis of these construct. (FILTERS IN PERCEIVING
REALITY).
ii. Because we need to alter or discard constructs, therapy became a
matter of revising old constructs and developing new ones.
iii. The first way created in family therapy was "reframing"-relabeling
behavior to shift how family members respond to it. For example, family
react differently when talking about "misbehavior" versus "hyperactive"
child.
iv. The social construction of reality: Constructivism says that we relate to
the world on the basis of our own interpretations. social
constructionism points out that those interpretations are shaped by the
social context in which we live. It is a deconstruction process
1. Focus solution therapy: seeking to know what clients do when
they are not having the problem. (forget about the current
failure and observe the successes in the past and what they did).
2. Narrative therapy: create a shift in their clients' experience by
helping them reexamine how they look at things (always try to
seek for the positive)
d. Attachment theory:
e. The working concepts of family therapy
i. interpersonal context: In therapy, the idea, that people are products of
their context. One can say that behavior is powerfully influenced by
interactions with other family members. This is not absolutist.
ii. complementarity: the idea that the complementarity of behaviors: if she
complaints all the time is only half of the story; he may be doing
something to case such behavior. That is, one person influence the
other creating a relationship. The therapist should work towards
developing skills to make it note that constant complain is not helping:
as she complains more, he continues to ignore more. Helping clients to
pass this behavior.
iii. circular causality: if you do something to someone, you dont know
what will happen; this in turn, can modify you next reaction. It is based
on the "feedback" system and influences.
iv. triangles: triangulation of dilemmas to other individuals within the
system.
v. process/content: the process of communication rather the "content" of
it. Maybe there is a passive-aggressive behavior and the way is being
expressed make the S2 reaction to it negatively.
vi. family structure:
vii. family-life cycle: the process of development that the family should
adopt as a whole system. Each member of the family should develop in
their order (infant, child, puberty).
viii. resistance: just as resistance is present in individuals; families also
present resistance to change. Therapy should work towards this
objective: flexibility.
ix. family narratives:
x. gender:
xi. culture:
V. CHAPTER 4: The classic schools of family therapy
a. theoretical formulations: Bowen's theory describes how the family, as a
multigenerational network of relationships, shapes the interplay of individuality
and togetherness using six interlocking concepts:
i. differentiation of self: the capacity to think and reflect, to not respond
automatically to emotional pressure. Undifferentiated people are easily
moved to emotionality. You asked them they think and they say what
they feel; you ask them what they believe and they will echo what they
have heard. Their live are ruled by reactivity to those around them.
Differentiated people tend to have emotional control; yet spontaneous.
ii. emotional triangles: literally the involvement of a third person in a
relationship. The relationship that faces difficulties faces anxiety; in
order to avoid such anxiety, they will stop talking about it because it
causes problems and difficulties. When this happen, the parties will
seek sympathy from another person; this in turn, causes the
triangulation.
iii. multigenerational emotional processes: inherence of emotional
dependency is practiced from generation to generation. Emotional forces
in families operate over the years in interconnected patters. Lack of
differentiation in family produces emotionally reactive children, which
may be manifest as emotional overinvolvement or emotional cutoff from
the parents, which in turn leads to fusion in new relationship-because
people with limited emotional resources tend to project all their needs
onto each other.
iv. sibling position:
v. emotional cutoff: describe how some people manage anxiety in
relationships. The greater the fusion between parents ad children, the
greater the likelihood of a cutoff. Some people seek distance by moving
away; others do so emotionally by avoiding intimacy or insulating
themselves with the presence of third parties.
vi. societal emotional process:
b. Normal family development: People from undifferentiated families will continue
to be undifferentiated when they from new families. Those who handled anxiety
by withdrawal will tend to do the same in their marriages. Therefore, Bowen
was convinced that differentiation of autonomous personalities, accomplished
primarily in the families of origin, was both a description of normal development
and a prescription of therapeutic progress. When individuals that are not
differentiated become partners they will be more likely to show deficits. When
they are not able to leave one system to another they exhibit difficulties. The
formation of an intimate partnership requires the partners to shift their primary
emotional attachment from their parents and friends to their mates. Making
wedding plans, choosing a place to live, buying a car, having a baby and
selecting school are times when this struggle may come explicit. When there is
difficulties with separation of family and the construction of a new system,
individuals will not show sharing shores (rearing children, decision making, etc).
c. Development of behavior disorder: symptoms results from stress that exceeds a
person's ability to manage it. The ability to handle stress is a function of
differentiation: the more well-differentiated people are, the more resilient they
will be and the more flexible and sustaining their relationships. In less well-
differentiated people, it takes less stress to produce symptoms. The difference
is that differentiation isn't just a quality of individuals but also a of
relationships. A person's basic level of differentiation is largely determined by
the degree of autonomy achieved in his or her family, but the functional level of
differentiation is influenced by the quality of current relationships. Thus a
somewhat immature person who mages to develop healthy relationships will be a
at less risk than an equally immature person who's alone or in unhealthy
relationship. The most vulnerable (in terms of isolation and lack of
differentiation) is most likely to absorb the anxiety in a system and develop
symptoms. According to Bowen the psychological dilemmas is the "emotional
fusion". Emotional fusion is based on anxious attachment, which may be
manifested either as depend or isolation. Both the overly dependent and the
emotionally isolated person respond with emotional reactivity to stress. Even
emotionally fused children eventually try to break away. But breaking away in
such instances tends to be accomplished by emotional cutoff, rather than
mature resolution of family ties. According to Bowen, people tend to choose
mates with similar levels of undifferentiating. When conflict develops, each
partner will be aware of the emotional immaturity--of the other one. Each will
be prepared for change--in the other one.
d. Goals of therapy: Therapy is an opportunity for people to learn a lot
themselves and their relationships so that they can assume responsibility for
their own problems. The therapist should guide in this process through
inquiring. Tracing the patterns of family problems means paying attention to
process and structure. Process refers to patterns of emotional reactivity;
structure, to interlocking networks of triangles.
e. Conditions for behavior change: Increasing the ability to distinguish between
thinking and feeling, and learning to sue that ability to resolve relationship
problem is the guiding principle of Bowenian therapy. Lowering anxiety and
increasing self-focus--the ability see one's own role in interpersonal process-is
the primary mechanism of change. UNDERSTANDING, not action, is the
vehicle of cure. Therapist ask questions to foster self-reflection, and they
direct at individual one at a time, rather than encourage family dialogues--
which have a tendency to overheated--.
f. Therapy: Bowenian therapy include genograms, process questions, relationship
experiments, detriangling, coaching, taking "I position", and displacement
stories.
i. assessment:
1. It begins with a history of the presenting problem (exact dates
are noted and later checked).
2. History of nuclear family history (parents met, their courtship,
their marriage, and childrearing.) Particular attention is paid to
where the family have moved, lived, and the location of the
extended family.
3. Next history of both spouses (births, siblings position, significant
facts about their childhood, and the functioning of their parents).
4. Genograms: are schematic diagrams showing family members and
their relationship to one another. What makes genogram more
than a static portraits of a family's history is the inclusion of
relationships conflicts, cutoffs, and triangles. Dates that
indicated a significant emotional distress are also noted.



ii. therapeutic techniques: Bowenian therapist believe that understanding
how family systems operate is more important than devising techniques.
Process questions are designed to explore what's going on inside people
and between them: "when your boyfriend neglects you, how do you
reacting?" "What about your wife's criticism upsets you most?".
Process questions are designed to slow people down and start them
thinking--not just about how others are upsetting them but about how
they participate in interpersonal problems. Bowenian's ask questions,
but they also move in occasionally to change, confront and explain.
iii. Betty Carter, for example, asks questions designed to help couples
understand their situation , but she then tries to move thins along by
explaining what works or doesnt work and by assessing tasks calculated
to move people out of triangles.
iv. For couples:
1. remain connected with both partners
2. Displacement stories (Guiering): telling a story about someone,
"Last year I saw a couple who just could not stop arguing long"..
v. For individuals: the same as with larger units: developing person-to-
person relationships, seeing family members as people rather thane
emotionally charged image, learning to recognize triangle, and finally,
detriangling oneself.