Experiential Family Therapy - Carl Whitaker and Virginia Satir

 

While Carl  and Virginia believed that emotional suppression is both the cause as well as the effect of problems in family, former thought self fulfillment depends on family cohesiveness whereas later believed importance of communication to solve problem in families.

Carl's approach was more pragmatic. He believes that theory often works more negatively than positively. A therapist should be open to first establish a relationship with client which is more important than confining to a theory which reduces the anxiety of therapist while dealing with a client. This therapy believes that each family has the right to be themselves, family is an integrated whole rather collection of individuals and family togetherness and cohesion are associated with personal growth. This is a bold approach with lots of creativity and importance being on genuineness. 

Reason behind actions :

1. to express one's own individuality, express oneself freely

2. be autonomous as well a feel one with family

3. have intimacy

4. self actualization

Where comes trouble :

problem in family arises from lack of family cohesiveness, lack of emotional closeness and sharing among family members. the needs of the family may be suppressing the rights of the individual. personal choice being compromised. family undergoing societal pressures and often use unhealthy methods to maintain family peace.                                         

GOALS OF THERAPY:

1. Promote growth, change, creativity, flexibility, spontaneity, and playfulness

2. Make the covert overt

3. Increase the emotional closeness of spouses and disrupt rigidity

4. Unlock defenses, enhance self-esteem, and recover potential for experiencing

5. Enhance individuation

Therapist Role 

Active and directive, personal involvement, help family members open up and be themselves by freely experiencing what they think and feel, uses here and now technique, unmask family secrets and aim higher intimacy. Teach family members effective ways of communication.

Process

engagement, involvement and disentanglement 

Techniques

presence of co therapist to improve objectivity, open room therapy, bring the family to the emotional stress and intensify the emotional climate and ease the turmoil through coaching them. to facilitate the process between each members in family in non defensive way. sculpting,  Choreography,  Conjoint family drawing,  Role playing,  Use of humor,  Puppet interviews,  Reconstruction,  Sharing feelings and creating an emotionally intense atmosphere,  Modeling and teaching clear communication skills (Use of “I” messages)  Challenge, use of self.

CONCEPTS:

 Honest emotion

 Suppress repression

 Family myths

 Mystification

Communication concepts

 Blaming

 Placating

 Being irrelevant/irreverent

 Being super reasonable

 Battle for structure

 Battle for initiative

Limitations : unstructured approach solely based on the therapists ability to handle families through intense emotional climate thus making it difficult to train others in the same area. Not recommended for fragile families. More towards quality of life rather alleviating symptoms.

Reference

http://www.powershow.com/view1/83f06-ZDc1Z/Experiential_Family_Therapy_powerpoint_ppt_presentation

http://www.powershow.com/view/11d3d3-M2IzZ/Experiential_Family_Therapy_powerpoint_ppt_presentation

http://www.powershow.com/view/3c81ea-ZjFhN/Communications_and_Experiential_Family_Therapy_powerpoint_ppt_presentation

Adlerian Family Therapy

Background

Alfred Adler (1870–1937), though an early collaborator with Sigmund Freud, was one of the first major figures to break away from Freudian psychoanalysis to establish an independent school of personality and psychotherapy. Adler’s formulations challenged Freudian theory, which understood human motivation as being biologically and instinctually driven. For Adler, individuals were social beings and were motivated by the drive to overcome feelings of inferiority and to achieve a sense of self-esteem, adequacy, and power within their social and relational worlds. A person’s character and personality including behaviors, perceptions, feelings, and thoughts illuminate how he or she fits into the social milieu (Sherman & Dinkmeyer, 1987).Alder and laterAdlerians viewed the family as the primary social matrix that exerts an influence on the formation of personality. A person’s sense of self-esteem, self-worth, and ability to establish healthy human
relations emerges from observing and interacting with parental models. With a focus on relationships and parenting strategies, Adlerian psychology clearly formed the basis for the child guidance movement. Most important,Alder with his emphasis on understanding the self within the social context provided a conceptual
framework for understanding human motivation as relational and social rather than individualistic and autonomous.

concepts :

Family atmosphere :

 each family has a unique family atmosphere which consists of the climate of relationships that exists between family members. because the family is a system according to adlerians and  each member influence others in the family/system. this is unique to each family and differs from one family to other. Parents serve as a role model for defining relationships, work and participation in the world also they act as emotional role model for children.

Family constellation and birth order :

Adler  often noted that the family system or constellation consisted of the parents, children, and even extended family members, but then he would immediately shift to a discussion of birth order. Adler made reference to essentially fi ve birth positions: only, oldest, second of only two, middle, and youngest.

Mistaken goals

There are two goals as described by adlerians. Life goals for the development of lifestyle and immediate goals for everyday behavior. for children who are misbehaving in family dreikurs lists four goals as motivational typology they are attention getting, power struggle, revenge and demonstration of inadequacy. additional goals include getting (attitude that they should get whatever they want) avoidance and self elevation. There is similar goals for adults as well. mistaken goals of parents when dealing with children include trying to demonstrate adequacy, attempting to display control, acting with revenge and responding with display of inadequacy .By keeping these interactive goal patterns in mind, Adlerians are able to make sense of both the children’s behaviors and the parental actions and reactions reported in family process. Goal recognition and disclosure is central to Adlerian family counseling and therapy.

Therapy goals : establish and support parents as effective leaders of the family

Techniques : goal disclosure, motivation modification

Therapist role : collaborator who seeks to join the family working with both the children and parent in an open forum counselling.

Limitation : process relies of changes effected by family members outside therapeutic setting which is not observable and more emphasis of therapists ability to assess family interaction and  make assumptions on mistaken goals. the democratic nature of the approach may not suit across all cultures and even all euro american families.

the following videos should help you guys in quick recall or to refresh your memory when you want to come back again after detailed study of the source given in reference section.

 

Reference

http://www.mapsadler.org/uploads/AdlerianThoeryTechniques.pdf

History of Family Therapy

Family Therapy (FT) as a distinct method did not actually emerge until 1960's. However the conceptual and clinical influences can be traced back to the end of the 18th century. The socio political economic conditions and major events which influenced the society and nourished the climate for the emergence of FT as a separate entity or requisite are those during the great depression era.  There was major shift when society moved from agrarian to industrial and people started migrating to nearby factory areas creating urban households. This along with other stress and strain imposed a need for an approach which we will discuss briefly.

FT as a treatment modality is the final product of contributions from several disciplines like psychology, sociology, cybernetics, anthropology and biology. The events, movements, and research in several other fields that brought about FT as a distinct clinical initiative and a specialty treatment are as follows :

1. Great Depression :
It was during this period that the United States witnessed a dramatic shift from an agrarian based society to an industrialized urban society. Because of this transition many urban families found themselves coping with an array of issues stemming from rapid social change resulting from the impact of the industrial revolution and rapid urbanization. Social problems such as poverty, increasing social dislocation, immigration, illiteracy, disease, exploited labor, and slum housing adversely impacted the lives of increasing numbers of individuals and families. Modernist view was that a perfect understanding of the societal problem would give a proper tool to eradicate it.

2. Emergence of Professional Social Work :
COS (Charity organization Society) and Settlement house movements emerged as a response to help the families suffering the transition in society. However their approach was different. The former assumed the problems having emerged from individual character or moral disturbance while the latter believed that the societal, neighborhood and surrounding conditions had delirious impact in families. However these movements along with problems of industrialization, shift from agrarian to industrial society, migration, crowded settlements, unsafe factory conditions, poverty, emerging women movement all led to a pressing need to treat individual in family. Not family as a whole yet.

3. Group Dynamics :
this began with settlement house movement when they tried to gather people to teach them life skills, training and so on, so when groups formed group research emerged. Individual in group has become an interest of study. because man is a social being. So did they find the impact of groups in individual task. And they started studying groups and its dynamics

4. Marriage and Family Counselling 1920's:
With light being shown upon problems in marriages, people came out of their homes and started to approach professional guidance for marital problems. Usually this include everyday problems in marriage, death of a person, pre marital counselling. these were psycho educational kind of.

5. Child guidance movement :

With progressive era, mentally ill underwent cruel institutionalization and then came clifford Beers movement. This reformed the mental health system with more humane approach. The child guidance movement initially began for delinquent kids teaching parents how to understand their children and respond to

them with the appropriate use of love and discipline. With research of Alfred adler and rudolf aimed at intervening problems as early as possible to remedy. One of the significant outcomes of this movement as it relates to the future

development of family therapy was as child guidance practitioners began to understand the child they began to examine the ways in which both social and family dynamics might influence the child’s psychological difficulties. For example, these practitioners began to recognize the importance of intervening with the

entire family units around child-focused issues. In addition there was a shift in understanding the causative factors in childhood psychological disorders. The child’s emotional stability was increasingly being understood as reflective of parental, especially maternal, child-rearing behaviors. While much of this understanding was informed by psychoanalytic theory there was an increased focus on the relational dynamics within the family.

6. Changes in the field of Psychology :
Autonomous self to relational self. Freud took the position that much of human behavior is motivated by unconscious sexual and aggressive instincts and that the expressions of these instincts are shaped by early childhood relationships between children and their parents. Freudian psychoanalytic theory was based on the concept of the embodied and autonomous self.

Adler’s formulations challenged Freudian theory, which understood human motivation as being biologically and instinctually driven. For Adler, individuals were social beings and were motivated by the drive to overcome feelings of inferiority and to achieve a sense of self-esteem, adequacy, and power within their social and relational worlds. A person’s character and personality including behaviors, perceptions,
feelings, and thoughts illuminate how he or she fits into the social milieu

Influenced by Adler, Sullivan’s theory of psychiatry, interpersonal analysis, was based on the theory that both interpersonal relationships and social forces play a critical role in the formation of the self. In his study of the social sciences, especially the sociological theories of George Herbert Mead, Sullivan understood that human behavior was motivated not only by the desire for physical satisfaction but more important by a drive to attain a sense of security in relationships.

7. Impact of Sociological theory in history of FT :
Many theorists were influenced by the field of sociology based on which their respective treatment strategies were formed. Structural functionalism and symbolic interactionism were two major influential theories.While the former studies society as being smaller units interacting with one another and requiring adaptation so when one unit is affected it affects the very other units in the structure, the latter postulated by george mead says  that is important for family therapy is the concept of the self. The self is not found solely through the process of inner reflection (the “I”). Rather it is discovered by taking on the role of the “other” and imagining how one’s sense of self is perceived from another’s perspective (the looking glass self or the “me”) From this sociological perspective the family is the interactional, communicative, and meaning-generating network that is critical in the formation of self.

8. 1950's Cybernetics, systems, communications and ecological theories and their impact:
Systems, cybernetics, communications, and ecological theories challenged the influences of psychoanalytic thinking, which was the dominant perspective from the early 1920s well into the late 1950s. With the exception of theorists such as Alfred Alder and Harry Sullivan, psychoanalytic theory focused on the individual and intrapsychic conflicts emanating from the experiences of childhood and the
fantasy life emanating from the inner psychological world. These new theories acknowledged that a person’s behavior is not determined solely by one’s internal world but that the social context is a powerful determinant
in shaping behavior. Furthermore individual psychopathology cannot be understood without a detailed appreciation of the psychosocial and ecological context of the individual and his or her family.

9. Theodore Lidz : Murray Bowen and Lymann Wyne Schizophrenia and family system areas of research : throw light on relevant ties between individual pathology as pathology in the family.

First generational family therapy : (based on anthropological and sociological work of Talcott Parsons
 they were interested in the components of the family system, the various units that make up the family and observe the activities and functions to provide a clue to how the family is structured. For them family is a boundary maintaining social system in constant transaction with environment of other systems.

Therapists and Approaches in Structural Functionalists

1. Murray Bowen
2. Nathan Ackerman
3. Ivan Nagy
4. John Elderkin
5. Salvador Minuchin

First generationl : Communicative and Interractional  therapists and approaches gave importance to race, gender, larger ecological point of view and historical and cultural context
1. Carl Whittaker
2. Jay Haley
3. Virginia Satir
4. Milan group


Second Generational/ Post Mordern approach

1. Solution focussed
2. Narrative

Third Generation

Evidence based approach



Reference : free source link : http://www.uk.sagepub.com/upm-data/35408_Chapter1.pdf


timeline neat demonstration :

http://www.timetoast.com/timelines/history-of-family-therapy

http://www.preceden.com/timelines/46781-history-of-family-counseling

Summary of Family Therapies : http://www.aamft.org/Institutes13/Supervision/Individual_Documents/Saturday/mft%20model%20charts%202012%20sup.pdf

http://www.scribd.com/doc/20296973/C6436-11th-Family

Contextual Family Therapy

Developed by        -       Ivan Boszormenyi-Nagy

It is a trans generational family therapy and an approach to individual psychotherapy

Overview

Nagy is perhaps best known for developing the contextual approach to family therapy, which emphasizes the ethical dimension of family development. Based on the psychodynamic model, contextual therapy accentuates the need for ethical principles to be an integral part of the therapeutic process. Nagy believes that trust, loyalty, and mutual support are the key elements that underlie family relationships and hold families together, and that symptoms develop when a lack of caring and liability result in a breakdown of trust in relationships

Reason for dysfunction in family - breakdown in trustworthiness hence the goal of the therapy is to develop a sense of fairness among family members by promoting mutual understanding and trust

Key Concepts

1. loyalties

2. egacies

3. entitlements

4. ledger

5. revolving state

6. relational ethics

7. Rejunction

Useful Links

http://www.contextualfamilyservices.org/contextualtherapy.asp

http://en.wikipedia.org/wiki/Ivan_Boszormenyi-Nagy

http://www.proprofs.com/flashcards/story.php?title=contextual-therapy-study-ca-mft-licensing-exam

Object relations Therapy

So this is all about Object Relations Therapy. This video gives you a brief explanation on Object Relations, Historical context, contributors, Goals of the therapy, Role of therapist, Its principles and finally assessment and intervention

Object Relations varies greatly from the dominant psychoanalysis viewpoint of self, human personality development, psychopathology and human life in general. Since Freud coined the term "objects" to refer to person in constructing drive psychology that person as an object through which one achieves instinctual gratification. But opposing to this thought the alternatives developed around relational, interractional and social domains of experience. 

Major contributors

1. Melaine Klein

2. Fairbairn

3. bowlby

4. winnicott

5. Margret Mahler

6. Edith Jacobson

7. Heinz Hartmann

8. Heinz Kohut  and so on

Add on videos which helps to retain concepts in mind

Resources :
http://www.theipi.org/about-ipi/teaching-philosophy/36-general/about-ipi/82-object-relations-therapy

http://www.goodtherapy.org/object-relations.html

http://www.sonoma.edu/users/d/daniels/objectrelations.html

Prayer for progress in studies

This is a beautiful Prayer found in a book "Prayers for committed christians"

It invokes Our Lady to help us with studies,

Who can make a perfect study companion than Our Lady

She is the perfect example of wisdom and humility

She is most merciful and ever ready to help us the best way.

I share this treasure with other students who are preparing for exam

In whatever state you are, she is the best problem solver and

gets you to Christ more quickly than anybody or anything.

 

Solution Focused Therapy

The following video explains in brief what is SFT

Developed by - Steve de shazer, Insoo and several others

Goal - To work towards solutions rather problems, and helping the clients understand that there is always as an exception in a problem and that exceptions are solutions

Prime therapy technique - Questioning

Types of Questioning / Key concepts :

1. Goal formulation questioning & miracle questioning

2. exception finding questioning
3. scaling

4. coping questioning

Relevance to Social Work :
It is a very brief treatment very much in line with Social work values such as client self determination, ethics, building on strengths and so on.

More on SFT :
1. Techniques

Additional Resources ;

http://www.brief.org.uk/view.php?item_id=123

http://www.getselfhelp.co.uk/sft.htm

Person Centered Therapy

Developed by 

- Carl Rogers

Principle - 

Human beings are inherently good and are capable of making changes or enhancing their situation

Goal -

 To make a conducive environment for the client with elements of unconditional positive regard, empathy and therapist congruence so that the client can explore oneself and change him/her to better adjust to reality

Role of Therapist -

 Catalyst

The video gives a short explanation from Rogers himself.

The podcast below is a humble effort to help you guys to know the overview of client centered or person centered therapy, role of therapist, conditions required for change, and key concepts.

The notable resources for more readings on Person centered therapy are :

The practice of social work by charles zastrow
http://www.health.harvard.edu/press_releases/client_centered_therapy

http://pandc.ca/?cat=carl_rogers&page=rogerian_therapy

http://en.wikipedia.org/wiki/Person-centered_therapy

http://en.wikipedia.org/wiki/Carl_Rogers

http://psychclassics.yorku.ca/Rogers/therapy.htm

Transactional Analysis

Developed by Eric Berne in 1950's TA is a effective psycho therapeutic approach, theory of personality and method of communication.

The following podcast will help you know certain basic concepts of TA.



Ego states :

Parent
Adult
Child

Types of Transactions :
Complementary, crossed and ulteriors

Life Positions :

I am ok - You're ok (healthy)
I am ok - You're not ok (paranoid)
I am not ok - You're ok (depressive/inferior)
I am not ok - you're not ok (problematic / hopeless)

Key concepts :

Transactions (3 types)
Games ("n" no of types)
Scripts
Life Positions (4 )
Strokes
Injunctions (negative messages sent between ego states)
Rackets
ego states (3 - parent, adult, child)

TA is an alternative to classical psychoanalysis which Berne felt had unnecessary difficult language or terms.

TA is used in therapy, business environment as well as real life situations.

Multimodel Therapy

Overview :

The above video is an excellent way to start knowing what is multimodel therapy. More than a therapy, it is an approach to psychotherapy.  Multimodal therapy is the approach to psychotherapy founded by Arnold Lazarus. Arnold Allan Lazarus was a South African psychologist who is known for his contributions to behavior therapy. Concurrently with the pioneering contributions of Albert Ellis and Aaron Beck, starting in the late 1950s and continuing through the 1970s, Lazarus developed what was arguably the first form of "broad-spectrum" cognitive behavioral therapy. Indeed, in 1958, Arnold Lazarus was the first person to introduce the terms "behavior therapy" and "behavior therapist" into the professional literature He later broadened the focus of behavioral treatment to incorporate cognitive aspects .When it became clear that optimizing therapy's effectiveness and effecting durable treatment outcomes often required transcending more narrowly focused cognitive and behavioral methods, Arnold Lazarus expanded the scope of CBT to include physical sensations (as distinct from emotional states), visual images (as distinct from language-based thinking), interpersonal relationships, and biological factors. The final product of Arnold Lazarus' approach to psychotherapy is called multimodal therapy and shares many of its assumptions and theorizing with Ellis' rational emotive behavior therapy. His scholarly output is prolific: more than 250 articles and chapters and 18 books, including his classic "The Principles of Multimodal Therapy". His interpersonal charisma, inculcated in his early South African/English upbringing, and his feisty temperament, forged in his early boxing experiences, coalesce into a powerful voice for technical eclecticism.

 Multimodal therapy also considers the patient’s personality or temperament a significant factor in forming a treatment that the patient will be most open to. Patients may have the same structural profile from their question, but their personalities will differ, and so will their receptiveness to the treatment. One of the advantages of multimodal therapy is that psychologists and therapists do not have to submit to just one psychological ideology, but rather, they are more open to using different strategies from different ideologies. This form of flexibility is called “technical eclecticism.” It is based on the idea that humans are biological beings that think, feel, act, sense, imagine, and interact; and that each of these "modalities" should be addressed in psychological treatment.

 Principle Multimodal therapy (MMT) is the approach to psychotherapy based on the idea that there are multiple modalities of each individual that should be addressed when both identifying and treating a psychological disorder. To say in simple terms MMT is customizing treatments for each individual. According to MMT, each individual is affected in different ways and in different amounts by each dimension of his or her personality, and should be treated accordingly in order for treatment to be successful. We are products of interplay among our genetic endowment, our physical environment, and out social learning history. To state that learning plays a central role in the development and resolution of our emotional problems is to communicate very little. For a connection to be made between events, they need to occur simultaneously or in close succession. An association may be said to exist when responses evoked by one stimulus are predictably and reliably similar to those provoked by another stimulus. In this regard, classical and operant conditionings are two central concepts. 

BASIC ID A very vital component to Lazarus’ MMT, BASIC ID refers to the seven dimensions of personality. In order to create a successful treatment for a specific individual, each dimension must be considered along with the individual’s deficits in each. “B” represents behavior, which can be manifested through the use of inappropriate acts, habits, gestures, or the lack of appropriate behaviors. “A” stands for affect, which can be seen as the level of negative feelings or emotions one experiences. “S” is sensation, or the negative bodily sensations or physiological symptoms such as pain, tension, sweat, nausea, quick heartbeat, etc. “I” stands for imagery, which is the existence of negative cognitive images or mental pictures. “C” represents cognition or the degree of negative thoughts, attitudes, or beliefs. The second “I” stands for interpersonal relationships, and refers to one’s ability to form successful relationships with others. It is based on social skills and support systems. Finally, “D” is for drugs and biological functions, and examines the individual’s physical health, drug use, and other lifestyle choices. MMT addresses the fact that different people depend on or are more influenced by some personality dimensions more than others. Some people are prone to deal with their problems on their own, cognitively, while others are more likely to draw support from others, and others yet are likely to use physical aspects to deal with problems, such as exercise or drugs. All reactions are a combination of how the 7 dimensions work together in an individual. Once the source of the problem is found, treatment can be used to focus on that specific dimension more than the others. 

CBT 

Multimodal therapy originated with cognitive behavioral therapy (CBT), which is a fusion of cognitive therapy and behavioral therapy. While purely cognitive therapy focused on mental aspects and internal processes, behavioral therapy contributed the consideration of external behaviors, making it possible to utilize both internal and external factors of treatment simultaneously. Further description of CBT: CBT merges the disciplines of cognitive therapy with behavioral therapy; while behavioral therapy focuses on external behaviors on their own, cognitive therapy contributes the cognitive, or mental aspects, focusing on internal thought processes. Put together, cognitive behavioral therapists can utilize both internal and external factors of treatment simultaneously. What Lazarus added to this is the idea that since personality is multi-dimensional, treatment must also be considered in this way in order to be effective. His idea of MMT involves examining symptoms on each dimension of personality in order to find the right combination of therapy to address them all.

The picture below shows an example of Multimodal Therapy for ADHD

 Assessment Multimodal assessment and treatment which follows BASIC I.D.: (i.e., seven interactive and reciprocally influential dimensions of personality/psychology or "modalities" which are Behavior, Affect, Sensation, Imagery, Cognition, Interpersonal relationships, and Drugs/biology, respectively). 

Client therapist relationship …in MMT is according to the choice of the client, either directive or reflective. The therapist asks client what they want at the beginning of the therapy session and how they want their therapist to act Lazarus’ Contributions MMT is a brief but comprehensive psychotherapy retained the basic premises of CBT, but believed that more of the individual’s specific needs and personality traits needed to be considered. He reasoned that since personality is multidimensional, treatment must also be considered in this way in order to be effective. His idea of MMT involves examining symptoms on each dimension of personality in order to find the right combination of therapies to address them all.

Additional Resource:

https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=1&cad=rja&ved=0CCkQFjAA&url=https%3A%2F%2Fwww.csub.edu%2F~bhartsell%2Fmultimodaltherapy.ppt&ei=0zf9UpuuJOiysQSI1IDQCg&usg=AFQjCNGfN7-mZWbbpbXmYvSfg7qw0LfIog&bvm=bv.61190604,d.cWc

http://www.get.gg/mmt.htm