- Information
- AI Chat
Mft model charts
Family Therapy (MFT 266)
Hofstra University
Related Studylists
MFTPreview text
Major Marriage and Family Therapy Models
Developed by Thorana S. Nelson, PhD and Students
STRUCTURAL FAMILY THERAPY
LEADERS
Salvador Minuchin Charles Fishman
ASSUMPTIONS:
Problems reside within a family structure (although not necessarily caused by the structure) Changing the structure changes the experience the client has Don’t go from problem to solution, we just move gradually Children’s problems are often related to the boundary between the parents (marital vs. parental subsystem) and the boundary between parents and children
CONCEPTS: Family structure Boundaries o Rigid o Clear o Diffuse o Disengaged o Normal Range o Enmeshment o Roles o Rules of who interacts with whom, how, when, etc. Hierarchy Subsystems Cross-Generational Coalitions Parentified Child
GOALS OF THERAPY:
Structural Change o Clarify, realign, mark boundaries Individuation of family members Infer the boundaries from the patterns of interaction among family members Change the patterns to realign the boundaries to make them more closed or open
ROLE OF THE THERAPIST:
Perturb the system because the structure is too rigid (chaotic or closed) or too diffuse (enmeshed) Facilitate the restructuring of the system Directive, expert—the therapist is the choreographer See change in therapy session; homework solidifies change Directive
ASSESSMENT:
Assess the nature of the boundaries, roles of family members Enactment to watch family interaction/patterns
INTERVENTIONS:
Join and accommodate o mimesis Structural mapping Highlight and modify interactions Unbalance Challenge unproductive assumptions Raise intensity so that system must change
CHANGE:
Raise intensity to upset the system, then help reorganize the system Change occurs within session and is behavioral; insight is not necessary Emotions change as individuals’ experience of their context changes
Structural Family Therapy, Continued
Interventions disorganize and reorganize Shape competence through Enactment (therapist acts as coach)
TERMINATION: Problem is gone and the structure has changed (2nd order change) Problem is gone and the structure has NOT changed (1st order change)
SELF OF THE THERAPIST:
The therapist joins with the system to facilitate the unbalancing of the system Caution with induction—don’t get sucked in to the content areas, usually related to personal hot spots
EVALUATION:
Strong support for working with psychosomatic children, adult drug addicts, and anorexia nervosa.
SUPERVISION INTERVENTIONS:
RESOURCES:
Minuchin, S. (1974). Families and family therapy. Cambridge, MA: Harvard University Press. Minuchin, S., & Fishman, H. C. (1981). Family therapy techniques. Cambridge, MA: Harvard University Press. Minuchin, S., Rosman, B. L., & Baker, L. (1978). Psychosomatic families. Cambridge, MA: Harvard University Press. Fishman, H. C. (1988). Treating troubled adolescents: A family therapy approach. New York: Basic Books. Fishman, H. C. (1993). Intensive structural therapy: Treating families in their social context. New York: Basic Books.
NOTES
Strategic Therapy (MRI), Continued
Interventions Skeptical of change Take a lot of credit and responsibility for change; however, therapist tells clients that they are responsible for change Active
INTERVENTIONS: Paradox Directives o Assignments (“homework”) that interrupt sequences Interrupt unhelpful sequences of interaction “Go slow” messages Prescribe the symptoms
CHANGE:
Interrupting the pattern in any way Difference that makes a difference Change occurs outside of session; insession change is in viewing; homework changes doing Change in viewing (reframe) and/or doing (directives) Emotions change and are important, but are inferred and not directly available to the therapist
TERMINATION: Client decides when to terminate with the help of the therapist When pattern is broken and the client reports that the problem no longer exists Therapist decides
SELF OF THE THERAPIST:
Therapist needs to be VERY careful with ethics in this model; it can be very manipulative (paradox) and a lot of responsibility is on the therapist as an expert
EVALUATION:
Very little research done Do clients report change? If so, then it is effective
SUPERVISION INTERVENTIONS:
RESOURCES:
Watzlawick, P., Weakland, J., &, Fisch, R. (1974). Change: Principles of problem formation and problem resolution. New York: Norton. Fisch, Richard, John H. Weakland, and Lynn Segal (1982). The tactics of change: Doing therapy briefly. San Francisco: Jossey-Bass. Watzlawick, P., J. B. Bavelas, and D. J. Jackson. (1967). Pragmatics of human communication. New York: W. W. Norton. Lederer, W. J., and Don Jackson. (1968). The mirages of marriage. New York: W. W. Norton.
NOTES:
STRATEGIC THERAPY (Haley & Madanes)
LEADERS:
Jay Haley Cloe Madanes Influenced by Minuchin
ASSUMPTIONS:
Family members often perpetuate problems by their own actions (attempted solutions) --the problem is the problem maintenance (positive feedback escalations) Directives tailored to the specific needs of a particular family can sometimes bring about sudden and decisive change People resist change You cannot not communicate--people are ALWAYS communicating All messages have report and command functions-- working with content is not helpful, look at the process Communication and messages are metaphorical for family functioning Symptoms are messages -- symptoms help the system survive It is only a problem if the family describes it as such Based on work of Gregory Bateson, Milton Erickson, MRI, and Minuchin Need to perturb system – difference that makes a difference (similar enough to be accepted by system but different enough to make a difference) Problems develop in skewed hierarchies Motivation is power (Haley) or love (Madanes)
CONCEPTS: Symptoms are messages Family homeostasis Family rules – unspoken Intergenerational collusions First and second order change Metaphors Reframing Symptoms serve functions Content & Process Report & Command Incongruous Hierarchies Ordeals (prescribing ordeals) Paradox Paradoxical Injunction Pretend Techniques (Madanes) “Go Slow” Messages
GOALS OF THERAPY:
Help the family define clear, reachable goals Break the pattern; perturb the system First and second order change- ideally second order change (we cannot make this happen-- it is spontaneous) Realign hierarchy (Madanes)
ROLE OF THE THERAPIST:
Expert position Responsible for creating conditions for change Work with resistance of clients to change Work with the process, not the content Directive Skeptical of change Take a lot of credit and responsibility for change; however, therapist tells clients that they are responsible for change Active
ASSESSMENT:
Define the problem clearly and find out what people have done to try to resolve it Hypothesize metaphorical nature of the problem Elicit goals from each family member and then reframe into one, agreed-upon goal Assess sequence patterns
MILAN FAMILY THERAPY
LEADERS:
Boscolo Palazzoli Prata Cecchin
ASSUMPTIONS:
problem is maintained by family’s attempts to fix it therapy can be brief over a long period of time clients resist change
CONCEPTS:
family games (family’s patterns that maintain the problem) o dirty games o psychotic games there is a nodal point of pathology invariant prescriptions rituals positive connotation difference that makes a difference neutrality hypothesizing therapy team circularity, neutrality incubation period for change; requires long periods of time between sessions
GOALS OF THERAPY:
disrupt family games
ROLE OF THERAPIST:
therapist as expert neutral to each family member – don’t get sucked into the family game curious
ASSESSMENT:
Family game Dysfunctional patterns (patterns that maintain the problem)
INTERVENTIONS:
Ritualized prescriptions Rituals Circular questions Counter paradox Odd/even day Positive connotation “Date” Reflecting team Letters Prescribe the system
CHANGE:
Family develops a different game that does not include the symptom (system change) Requires incubation period
TERMINATION:
Therapist decides, fewer than 10-12 sessions
EVALUATION:
Not practiced much, therefore not researched Follow up contraindicated SUPERVISION INTERVENTIONS:
Milan Family Therapy, continued
RESOURCES:
Campbell, D., Draper, R., & Huffington, C. (1989). Second thoughts on the theory and practice of the
Milan approach to family therapy. New York: Karnac.
Campbell, D., Draper, R., & Crutchley, E. (1991). The Milan systemic approach to family therapy. In
A. S. Gurman & D. P. Kniskern (Eds.), Handbook of Family Therapy (Vol. II) (pp. 325-362).
New York: Brunner/Mazel.
Cecchin, G. (1987). Hypothesizing, circularity, and neutrality revisited: An invitation to curiosity.
Family Process, 26(4), 405-413.
Cecchin, G. (1992). Constructing therapeutic possibilities. In S. McNamee & K. J. Gergen (Eds.),
Therapy as social construction (pp. 86-95). Newbury Park, CA: Sage.
Palazzoli, M. S., Boscolo, L., Cecchin, G., & Prata, G. (1978). Paradox and counterparadox: A new
model in the therapy of the family in schizophrenic transaction. New York: Jason Aaronson.
Palazzoli, M. S., Boscolo, L., Cecchin, G., & Prata, G. (1978). A ritualized prescription in family
therapy: Odd days and even days. Journal of Marriage and Family Counseling, 48, 3-9.
Palazzoli, M., & Palazzoli, C. (1989). Family games: General models of psychotic processes in the
family. New York: W. W. Norton & Company.
NOTES:
Solution-Focused Brief Therapy, Continued
Interventions Formula first session task: Observe what happens in their life/relationship that they want to continue Miracle question: -Used when clients are vague about complaints -Helps client do things the problem has been obstructing -Focus on how having problems gone will make a difference -Relational questions -follow up with miracle day questions and scaling questions -pretend to have a miracle day Scaling questions
Midsession break (with or without team) to summarize session, formulate compliments and bridge, and suggest a task (tasks used less in recent years; clients develop own tasks; therapist may make suggestions or suggest “experiments”), sometimes called “feedback” (feeding information back into the therapy with a difference) Predict the next day, then see what happens
TERMINATION: Client decides
SELF OF THE THERAPIST:
Accept responsibility for client/therapist relationship Expert on therapy conversation, not on client’s life or experience of the difficulty
EVALUATION: Therapy/Research: Simple (not necessarily easy) Can be perceived that therapist as insensitive- “Solution Forced Therapy” Crucial that clients are allowed to fully express struggles and have their own experiences validated, BEFORE shifting the conversation to strengths
Techniques can obscure therapist’s intuitive humanity Many outcome studies show effectiveness, but no controlled studies
Progress of therapy: Can clients see exceptions? Are they using solution talk?
SUPERVISION INTERVENTIONS:
RESOURCES:
de Shazer, S. (1982). Patterns of brief family therapy: An ecosystemic approach. New York: Guilford.
de Shazer, S., Dolan, Y., Korman, H., Trepper, T., McCollum, E., & Berg, I. K. (2007). More than
miracles: The state of the art of solution-focused brief therapy. New York: Haworth.
Berg, I. K., & Miller, S. (1992). Working with the problem drinker. New York: Norton. Berg, I. K. (1994). Family-based services: A solution-focused approach. New York: Norton. De Jong, P., & Berg, I. K. (2007). Interviewing for solutions (3rd ed.). Pacific Grove, CA: Brooks/Cole. Dolan, Y. (1992). Resolving sexual abuse. NY: W. Norton. Lipchik, E. (2002). Beyond technique in solution focused therapy. New York: Guilford. Miller, S. D., Hubble, M. A., & Duncan Barry L. (Eds.). (1996). Handbook of solution-focused brief therapy. San Francisco: Jossey-Bass. Nelson, T. S., & Thomas, F. N. (Eds.). (2007). Handbook of solution-focused brief therapy: Clinical applications. New York: Haworth.
NOTES:
NARRATIVE THERAPY
LEADERS:
Michael White David Epston Jill Freedman Gene Combs
ASSUMPTIONS:
Personal experience is ambiguous Reality is shaped by the language used to describe it – language and experience (meaning) are recursive Reality is socially constructed Truth may not match historic or another person’s truth, but it is true to the client Focus on effects of the problem, not the cause (how problem impacts family; how family affects problem) Stories organize our experience & shape our behavior The problem is the problem; the person is not the problem People “are” the stories they tell The stories we tell ourselves are often based on messages received from society or our families (social construction) People have their own unique filters by which they process messages from society
CONCEPTS: Dominant Narrative - Beliefs, values, and practices based on dominant social culture Subjugated Narrative – a person’s own story that is suppressed by dominant story Alternative Story: the story that’s there but not noticed Deconstruction: Take apart problem saturated story in order to externalize & re-author it (Find missing pieces; “unpacking”) Problem-saturated Stories - Bogs client down, allowing problem to persist. (Closed, rigid) Landscape of action: How people do things Landscape of consciousness: What meaning the problem has (landscape of meaning) Unique outcomes – pieces of deconstructed story that would not have been predicted by dominant story or problem-saturated story; exceptions; sparkling moments
GOALS OF THERAPY:
Change the way the clients view themselves and assist them in re-authoring their story in a positive light; find the alternative but preferred story that is not problem-saturated Give options to more/different stories that don’t include problems
ROLE OF THERAPIST:
Genuine curious listener Question their assumptions Open space to make room for possibilities
ASSESSMENT:
Getting the family’s story, their experiences with their problems, and presumptions about those problems. Assess alternative stories and unique outcomes during deconstruction
INTERVENTIONS: Ask questions o Landscape of action & landscape of meaning o Meaning questions o Opening space
CHANGE:
Occurs by opening space; cognitive Client can see that there are numerous possibilities Expanded sense of self
COGNITIVE-BEHAVIORAL THERAPY
LEADERS:
Ivan Pavlov Watson Thorndike B. F. Skinner Bandura Dattilio
ASSUMPTIONS:
Family relationships, cognitions, emotions, and behavior mutually influence one another Cognitive inferences evoke emotion and behavior Emotion and behavior influence cognition
CONCEPTS:
Schemas- core beliefs about the world, the acquisition and organization of knowledge Cognitions- selective attention, perception, memories, self-talk, beliefs, and expectations Reinforcement - an event that increases the future probability of a specific response Attribution- explaining the motivation or cause of behavior Distorted thoughts, generalizations get in way of clear thinking and thus action
GOALS OF THERAPY:
To modify specific patterns of thinking and/or behavior to alleviate the presenting symptom
ROLE OF THERAPIST:
Ask a series of question about assumptions, rather than challenge them directly Teach the family that emotional problems are caused by unrealistic beliefs
ASSESSMENT:
Cognitive: distorted thoughts, thought processes Behavioral: antecedents, consequences, etc.
INTERVENTIONS:
Questions aimed at distorted assumptions (family members interpret and evaluate one another unrealistically) Behavioral assignments Parent training Communication skill building Training in the model
CHANGE:
Behavior will change when the contingencies of reinforcement are altered Changed cognitions lead to changed affect and behaviors
TERMINATION:
When therapist and client determine
SELF OF THE THERAPIST:
Not discussed
EVALUATION: Many studies, particularly in terms of marital therapy and parenting
SUPERVISION INTERVENTIONS:
RESOURCES:
Jacobson, N. S., & Margolin, G. (1979). Marital therapy: Strategies based on social learning and behavior exchange principles. New York: Brunner/Mazel. Jacobson, N. S., & Christensen, A. (1998). Acceptance and Change in Couple Therapy: A Therapist's Guide to Transforming Relationships. New York: Norton. Epstein, N. B., & Baucom, D. H. (2002). Enhanced cognitive-behavioral therapy for couples. Washington, DC: APA Books. Resources Dattilio, F. M. (1998). Case studies in couple and family therapy: Systemic and cognitive perspectives. New York: Guilford. Dattilio, F. M., & Padesky, C. (1990). Cognitive therapy with couples. Sarasota, FL: Professional Resource Press. Beck, A. T., Reinecke, M. A., & Clark, D. A. (2003). Cognitive therapy across the lifespan: Evidence and practice. Cambridge, UK: Cambridge University Press.
NOTES:
Contextual Family Therapy, Continued
RESOURCES:
Boszormenyi-Nagy, I. (1987). Foundations of contextual therapy: Collected papers of Ivan Boszormenyi-Nagy. New York: Brunner/Mazel. Boszormenyi-Nagy, I., & Krasner, B. (1986). Between give and take: A clinical guide to contextual therapy. New York: Brunner/Mazel.
Hargrave, T. D., & Pfitzer, F. (2003). The new contextual therapy: Guiding the power of give and take.
New York: Brunner-Routledge.
van Heusden, A., & van den Eerenbeemt, E. (1987). Balance in motion: Ivan Boszormenyi-Nagy and his vision of individual and family. New York: Brunner/Mazel.
NOTES:
BOWEN FAMILY THERAPY
LEADERS:
Murray Bowen Michael Kerr (works with natural systems) Edwin Friedman
ASSUMPTIONS:
The past is currently influencing the present Change can happen—individuals can move along in the process of differentiation Differentiation: ability to maintain self in the face of high anxiety (remain autonomous in a highly emotional situation) o Change in experience of self in the family system o Change in relationship between thinking and emotional systems Differentiation is internal and relational—they are isomorphic and recursive Anxiety inhibits change and needs to be reduced to facilitate change High intimacy and high autonomy are ideal Emotions are a physiological process—feelings are the thoughts that name and mediate emotions, that give them meaning Symptoms are indicators of stress, anxiety, lower differentiation Anyone can become symptomatic with enough stress; more differentiated people will be able to withstand more stress and, when they do become symptomatic, recover more quickly
CONCEPTS: Intimacy Autonomy Differentiation of Self Cutoff Triangulation Sibling position Fusion (within individual and within relationships) Family projection process Multigenerational transmission process Nuclear family Emotional process 4 sub-concepts (ways people manage anxiety; none of these is bad by itself – it’s when one is used to exclusion of others or excessively that it can become problematic for a system): o Conflict o Dysfunction in person o Triangulation o Distance Societal emotional process Undifferentiated family ego mass
GOALS OF THERAPY:
Ultimate—increase differentiation of self (thoughts/emotions; self/others) Intermediate—detriangulation, lowering anxiety to respond instead of react Decrease emotional reactivity—increase thoughtful responses Increased intimacy one-on-one with important others
ROLE OF THERAPIST:
Coach (objective) Educator Therapist is part of the system (non-anxious and differentiated) Expert—not a collaborator
ASSESSMENT:
Emotional reactivity Degree of differentiation of self Ways that people manage anxiety/ family themes Triangles Repeating intergenerational patterns Genogram (assessment tool)
PSYCHODYNAMIC FAMILY THERAPY (OBJECT RELATIONS)
LEADERS:
Freud Erik Erikson Nathan Ackerman Several others who were trained, but their models were not primarily psychodynamic: Bowen, Whitaker, etc. Object relations: Scharff & Scharff Attachment theory: Bowlby
ASSUMPTIONS:
Sexual and aggressive drives are at the heart of human nature Every human being wants to be appreciated Symptoms are attempts to cope with unconscious conflicts over sex and aggression Internalized objects become projected onto important others; we then evoke responses from them that fit that object, they comply, and we react to the projection rather than the real person Early experiences affect later relationships Internalized objects affect inner experience and outer relationships
CONCEPTS:
Internal objects- mental images of self and others built from experience and expectation Attachment- connection with important others Separation-individuation- the gradual process of a child separating from the mother Mirroring- When parents show understanding and acceptance Transference-Attributing qualities of someone else to another person Countertransference – Therapist’s attributing qualities of self onto others Family Myths- unspoken rules and beliefs that drive behavior, based on beliefs, not full images of others Fixation and regression-When families become stuck they revert back to lower levels of functioning Invisible loyalties- unconscious commitments to the family that are detrimental to the individual
GOALS OF THERAPY:
To free family members of unconscious constraints so that they can interact as healthy individuals Separation-Individuation Differentiation
ROLE OF THERAPIST:
Listener Expert position Interpret
ASSESSMENT:
Attachment bonds Projections (unrealistic attributions)
INTERVENTIONS:
Listening Showing empathy Interpretations (especially projections) Family of origin sessions (Framo) Make a safe holding environment
CHANGE:
Change occurs when family members expand their insight to realize that psychological lives are larger than conscious experience and coming to accept repressed parts of their personalities Change also occurs when more, full, real aspects of others are revealed in therapy so that projections fade
Psychodynamic Family Therapy (Object Relations), Continued
TERMINATION:
Not sure how therapy is terminated
EVALUATION:
SUPERVISION INTERVENTIONS:
RESOURCES:
Sander, F. (2004) Psychoanalytic Couples Therapy: Classical Style in Psychoanalytic Inquiry Issue on Psychoanalytic Treatment of Couples ed. By Feld, B and Livingston, M. Vol 24:373-386. Scharff, J. (ed.) (1989) Foundations of Object Relations Family Therapy. Jason Aronson, Northvale N. Slipp, S. (1984). Object relations: A dynamic bridge between individual and family treatment. Northvale, NJ: Jason Aronson.
NOTES:
Mft model charts
Course: Family Therapy (MFT 266)
University: Hofstra University
- Discover more from:
