Marriage and Family: Role theory: Each member has a specific role.

. Changing in one role can change the whole dynamic of the family. Each role SHOULD be multidimensional and flexible. Worry about roles becoming permanent. At the same time, you do not want to take on too many roles. Group vs. Family Therapy: Cohesiveness already exists a lot of time The roles are different, what you as therapist do with them and they are already in place between the members of a family. Remember that Schizophrenia and Eating Disorders were discussed. Social Work: Major influence in the development of family theories. Illuminated the influence of familial factors in problem behaviors. Fundamental Concepts: Two primary components to early family therapy. General Systems Theory Cybernetics General Systems Theory: System is an entity that is maintained by mutual interactions of its components. Actions of interacting components are best understood by studying them in their context. Cybernetics: Describes process by which individuals receive information feedback loops Two Types: - Negative Feedback Loops reduce deviation and help system maintain its status quo. - Positive Feedback Loops amplifies deviation or change disrupts system. Palo Alto: Research centers led to prominent features of family functioning. Identified communication as robust predictor of healthy functioning Developed Communication Interaction Family Therapy....communication leads to dysfunction. Content Vs. Process What is the focal point of communication. The Process: the how and why you say something The Content: what is actually said

Mechanisms of Communication: Double Bind Communication: involve conflicting negative injunctions. - One injunction is expressed verbally, while the second injunction is expressed non-verbally. - Recipient of double bind is not allowed to comment on conflicting nature or seek help from someone else. - Mixed message. - Often seen in abusive relationships: Tell the therapist how you feel If you tell him too much your dead Communication occurs all the time - Two main components: 1. Report: content of a communication. 2. Command: often conveyed non-verbally and makes statement about the relationship between communicators. Interaction patterns: - Two Types: 1. Symmetrical Communications: reflect equality between communicators by may escalate into competitive game 2. Complementary communications: reflects inequality and maximizes differences between communicators one assumes dominant role while other assumes passive role. Maladaptive Behavior: Circular model of causality - Symptoms are caused and an effect of dysfunctional communication patterns. - Patterns include blaming, criticizing, mindreading, and over generalizing. - Set up dynamics that alleviate the concerns. Many times alleviating the symptoms rather than just talking it out loud. Intakes: Confidentiality: most important ethical concern in family therapy wider array of ethical problems who is the client? What is abuse and who is vulnerable to be abused? Setting guideline I.e only having sessions when whole family is there Important information for an intake: Remember it takes longer...more people. Be concise. The problem....info in regards to it. Very detailed from all perspectives. What have they done to work on it? Where are they comfortable in functioning. Homeostatic level, roles, structure, etc. Background history to the family. Maybe give them a genogram. Medical history: psych and physical Abuse, Suicidality, aka basic safety

Intake checklist: Make contact with every member Establish leadership Develop working alliance Maintain empathy and build relationship with family focus on presenting concerns instill hope set goals dependent upon approach invite questions educate and empower Strategic Family Approach intakes: offers a lot of structure in completing a thorough intake Four stages - Social Stage: therapist elicits interaction between family members. NOT discussing problem. Encourages interactions between members. Therapist observes the interactions ( looking at dynamic, homestasis). - Problem Stage: what brought you in. obtain interpretation from family, but you can ask for some more elaborations. Make sure you cover all angles. Find out the event that initiated therapy. - Interaction Stage: main concern to solidify impressions of family dynamics and conceptualizations of difficulties. Observation is key. Allows for therapist to interact some asl bridging questions and solicit info about specific topics that are broached. Free time to ask any member about impressions and methods of interaction. - Goal Setting Stage: final stage sets course for therapy. By third or fourth session you will probably want a nice contract for the family about attendance, progress of goals, educate on therapy. All members must agree on contract. Can be tightened and refined later. Process of therapy: Three stages - Early phase: narrowing and solidifying dysfunction. Continue to strengthen alliances make suitable for confrontation. Instill and solidify investment and hope with clients. All leading up for a push for outcome. - Middle Phase: Build independence within family to govern itself. Therapist becomes a facilitator but not a cause for change must instill autonomy and efficacy within clients. Help transition between levels of progress and evaluate and re-evaluate goals. - Termination: You want to see autonomy. Set future plans. Treatment Plans: Two Main points to realize: Integration: Tx plans with family should focus on the entire family. Should incorporate everyone's input. More people = more difficult. - the broader the treatment plan the better! Inclusive: Steps need to consider active involvement from all individuals. Tx plans are often conceptualized as a contract. - Need everyone's approval. - Feedback is needed.

Two Types of Tx Plans: 1. Multi-faceted: multi goal - Develop around multiple identified problems. More comprehensive but less concentrated. Problems are illustrated through goals. 2. Concentrated goal: multiple objectives - Only one identified problem. Exploration of single problem from multiple pathways. Multiple objectives from one goal. Objectives need to be related but incrementally different. Components of the Tx Plan: Goals: statements reflective of the identified problem. Worded in an active process of progression. Objectives: statements concerning pathways in which the goal can be achieved. Steps: individual processes oriented towards meeting the objectives set forth within the Tx plan. Implementation points of the Tx plan. Intake Demonstrations: timing questions inclusiveness being open listening don't run over clients Family Systems: Techniques are not as focused on. Mostly theoretically based. Offers a lot of flexibility. A totally integrational theory. - Murray Bowen Psychiatrist at the Menninger Clinic Main interest in schizophrenia Three interlocking concepts: 1. Differentiation of self: a person's ability to separate his/her emotions from their intellect. 2. Triangulation: Anxiety is produced between two individuals as a reaction to stress or turmoil; a third person is brought in system to increase stability and reduce tension. Fixed vs. Temporary 3. Family Projection process: Process by which parental conflicts and emotional immaturity are transmitted to children causing a child to have a lower level of differentiation of his/her parents. View of maladaptive behavior: Multigenerational transmission process: progressively lowers the levels of differentiation from one generation to the next. Therapeutic goals: Increase differentiation of all family members.

Strategic Family Therapy: Erickson, Haley, Jackson, Weakland were primary figures in developing Strategic Approach Based highly upon communication (Feedback loops) Behaviorally based Combines systems theory and cybernetics into solution focused approach Commonly used with minorities Tend to focus on change, outwit resistance Extension: What is the structure of the family What is the family homeostasis Double bind Report/Command functions Feedback loops - focus on primary positive feedback loops Change: Focus on how a family approaches difficulties Let go of insight and acceptance Finding solutions to these difficulties is paramount adopt aspects of solution focused therapies - focus on solutions and outcome rather than problem - reject value of insight - therapeutic sessions are structured around several cognitive or behavioral - change is the only desired outcome View of maladaptive behavior: Emphasize the role of communication in maladaptive behavior; especially how one uses it to increase control in relationships Symptoms = interpersonal phenomenon that represents a strategy for controlling relationships when all other strategies have failed - Symptoms are a result of incongruous hierarchies - Chronic symptoms are maintained through misguided solutions positive feedback escalations (i.e. Denial, etc.) Controlling strategies are inherent in any relationship pathological when there is denial denial produces symptomatic behavior Therapy Goals: Alleviate family's current symptoms Alter family's transactions and organization - Especially hierarchies and boundaries - Focus on behavioral and cognitive interventions Insight is counter-productive Role of Therapist: Assume active, take-charge role

- Role must be stabilized during the first session (most important session & highly structured) Utilize a variety of techniques that are tailored to the family and it's problems Assessment: Three step process - 1st two steps help target points of intervention, while third helps determine how to approach - 1st step: define resolvable complaint - 2nd step: identify attempted solutions that maintain complaint - 3rd step: understand client's unique language in describing the problem Techniques: Flexible in terms of techniques that could be used again techniques are to be tailored to family difficulties Common techniques: - Directives - Paradoxical Interventions Directives: Assignments to be performed outside of therapy - Often involves a straightforwards instruction form the therapist Example: A father always tries to intervene when his wife and his sons are arguing. The therapist might ask him not to intercede the next time an argument occurs. Paradoxical Interventions: Developed from Erickson's application of hypnotherapeutic principles - Turn resistance into advantage Understand resistance may be opportunity for change Ordeals: Used to counter problem payoff appropriate to use when price for keeping symptoms outweighs that of giving up Essentially, give a client an unpleasant task task that client must perform whenever a symptoms occurs - Example: A man argues with this mother in law every time she comes to his house for xmas. As such, the therapist instructs the man to give his mother in law an expensive gift everytime he argues with her. Restraining: MRI Approach Therapist encourages clients not to change -Useful for clients who change too fast - Helps keep therapist in one-down position fosters autonomy Allow for time for their own look at their problems Positioning: Therapist amplifies or exaggerates family's explanation of symptoms to a point where the family will disagree Best used when individuals are labeling each other a lot, or adolescents Set you up with reframe opportunity

Reframing: Simply placing the symptom in another frame of reference. Use a framework that alters the outlook in such a way that makes the behavior undesirable. Positive connotations related to Milan theory Prescribing the Symptom: Requiring the client to engage in troublesome symptoms with some minor alterations. Structural Family Therapy: Found to work well with minorities Eclectic History: Developed by Salvador Manuchin Worked with lower SES Concerned with blueprint for the family - internal framework - reinforced through rules and expectations - heirarchical structure foundations - interventions effective when... centered around here and now, directive, concrete Be genuine, no psychobabble. Major Elements: Power hierarchies: how do members combine forces during times of conflict Nail down the family structure, and then you will be able to commence with therapy. Should have a good idea by the end of the first session. Subsystems: Coalitions that are central to specific context. - May revolve around conflict, these are of great interest - How does the family approach conflict. Boundaries: - How is the structure defined - Barriers or rules that dictate amount of contact allowed between and among coalitions. - Can we as a therapist or strengthen a boundary? Common Boundary Problems: Rigid Triads: - Detouring 1. Focus on children: overprotecting, blaming - Stable coalitions: 1. Cross-generational coalition: ganging-up and alienating - Triangulation 1. Un-winnable demands are placed upon child: push and pull