Model of Family Therapy

View of Normal Family Functioning

View of Dysfunction or Symptoms

Goals of Therapy

PROBLEM-SOLVING APPROACHES

Structural

(Salvador Minuchin,

Harry Aponte)

1.  Generational hierarchy with strong parental authority

2.Boundaries and subsystems

3.  Flexibility of system for:

a.  Autonomy  and inter- dependence

b.  Continuity and adaptive restructuring to fix changing internal and external demands

No families are problem-free.

Symptoms result from current family structural imbalance:

1.  Malfunctioning generational hierarchy, boundaries

2.  Enmeshed or disengaged style.

3.  Maladaptive reactions to changing demands (developmental, environmental)

Reorganize family structure:

1.  Shift members relative positions to disrupt malfunctioning pattern and strengthen parental hierarchy.

2.  Reinforce clear, flexible boundaries.

3.  Mobilize more adaptive alternative patterns.

Strategic or Systemic

(Jay Haley & Chloe Madanes)

(Luigui Boscolo, Gianfranco Cecchin, Lynn Hoffman Milan group)

1.  Flexibility

2.  Large behavioral repertoire for:

a.  Problem resolution

b.  Life-cycle passage

Symptom is a communicative act embedded in interaction pattern.

Multiple origins of problems; symptoms maintained by:

1.  Unsuccessful problem-solving attempts.

2.  Impasse at life-cycle transition.

3.  Rigid view, paucity of alternatives.

1.  Resolve presenting problem; specific pragmatic objectives.

2.  Interrupt rigid feedback cycle:  change symptom-maintaining sequence to new outcome

3.  Shift perspective to enable more empowered position.

Model of Family Therapy

View of Normal Family Functioning

View of Dysfunction or Symptoms

Goals of Therapy

SOCIAL LEARNING THEORIES

Resilience

(Froma Walsh,

Hamilton McCubbin)

1.  Wide range of family types and established patterns.

2.  Hardy

3.  Coherent

4. Flexible

5. Resistance resources able and capable to manage stressors and demands

6. In Balance

1.  Pileup of demands and stressors

2.  Maladjustment to stressors provokes crisis response

3.  Existing family patterns and schemas are disrupted.

Return family to balance

1.  Increase family resources and social support with multisystem, community based interventions.

2.  Help family to find new appraisals of stressors and demands and new problem solving and coping capacities

3.  Explore family paradigms, sense of coherence and schemas

Social Learning Theory

(Gerald Patterson)

1.  Adaptive behavior is rewarded; maladaptive behavior is not.

2.  Exchange of benefits outweighs costs; reciprocity.

3.  Communication and problem solving ability.

4.  Flexibility

Maladaptive, symptomatic behavior reinforced by:

1.  Family attention and reward.

2.  Deficient exchanges (e.g., coercive, skewed).

3.  Communication deficits

Concrete observable behavioral goals:

1.  Change contingencies of social reinforcement.

2.  Reward adaptive behavior, not maladaptive.

3.  Communication, problem-solving skills training

PSYCHO-EDUCATIONAL

(Anderson)

Successful coping and mastery of developmental challenges:

1.  Caregiving in chronic illness

2.  Tasks and skills in couples' relationships and family life

1.  Stress / diathesis in

biologically based disorders

2.  Normative and non-normative stresses (e.g. in couples' relationships, parenting, remarriage, adverse life events).

Information, coping skills, and social support for:

1.  Family management of chronic illness.

2.  Stress and stigma reduction.

3.  Mastery of family adaptational challenges.

TRANSGENERATIONAL GROWTH APPROACHES

Psychodynamic/Contextual

 (Ivan Boszormenyi-Nagy, Barbara Krasner)

1. Parental personalities and relationships well differentiated.

2. Relationship perceptions based on current realities, not projections from the past.

3. Provide context of security, trust, nurturance for bonding, and individuation

Symptoms due to shared family projection process stemming from unresolved conflicts, loyalty issues, and losses in family of origin.

1. Scapegoating

2. Unconscious role assignment

3. Early trauma, inner conflict

1. Insight and resolution of family of origin conflicts and losses

2. Awareness of self and other family members.

3. Decrease family projection processes.

4. Relationship reconstruction and reunion

5. More empathic relating; expression and resolution of emotions.

Communication/Experimental

(Virginia Satir

& Whitaker)

1. High self-worth.

2. Clear, honest communication

3. Flexible, appropriate family rules and roles

4. Open, hopeful social links.

5. Evolutionary growth, change.

6. Pleasurable, playful interaction

1. Symptoms are nonverbal messages in reaction to current communication dysfunction in system.

2. Blocked conflict resolution.

3. Dysfunctional rules and roles

1. Direct, clear communication through immediate shared experience.

2. Catalyze exploration experimentation, spontaneity.

3. Genuine nondefensive relating

4. Honest communication of feelings and needs.

5. Constructive and flexible family rules and roles.

Model of Family Therapy

View of Normal Family Functioning

View of Dysfunction or Symptoms

Goals of Therapy

SOLUTION BASED

Solutions

(Steve de Shazer

  & Insoo Kim Berg)

1.  See human life as a constantly changing process.

2.  Don't fix what isn't broke.

3.  Do more of what works.

4.  If something doesn't work, don't do it again, do something different.

1.  Doesn't believe problem exists when actually needing helping system

2.  Lack of independence or sense of autonomy--e.g., presents as innocent bystanders who have to endure difficulties others inflict.

3.  Strained relations with family of origin or support systems

Construct solutions rather than dissolving problems.

1.  Recognize pre-session change.

2.  Find exceptions

a.  Deliberate

b.  Random

3.  Negotiate goals

a.  Set defined number of sessions -or-

b.  Use "miracle question"

Model of Family Therapy

View of Normal Family Functioning

View of Dysfunction or Symptoms

Goals of Therapy

Narrative

(Michael White)

1.  Families do the best they can given the options available to them.

2.  All families have personal and social strengths and resources.

3.  Families will make changes when change is understood as beneficial and when the means for change are made available.

1.  Families "get into trouble" when they see no other viable options than those which are causing problems for themselves or  others.

2.  Alternative options are not available because of  limitations in resources or because stories or beliefs render certain options inaccessible or invisible.

1.  Written and verbal discourse with families acknowledges the validity of their stories and experiences as told to us without judgment or interpretations based on notions of right or wrong.

2.  Written and verbal discourse with families seeks to multiply the voices and stories told by others or the self, thereby multiplying the range of choices and possibilities for change.

Model of Family Therapy

View of Normal Family Functioning

View of Dysfunction or Symptoms

Goals of Therapy

Feminist

(Betty Carter,

Peggy Papp, Marianne Walters)

1.  Families are not gender free or "neutral".

2.  Role symmetry where each gender engages in both instrumental and expressive tasks both work and nurturing.

3.  Maturity is defined as autonomy with connectedness.

1.  Role complementarity:  instrumental tasks like earning money are male, and emotional tasks like nurturing are female.

2.  Organization of power is based on male hierarchy.

3.  Autonomy and connectedness are split.  Autonomy (male) is valued with both power and emotional disconnectedness, while women are assigned "dependency" with both the emotional connectedness and powerlessness

1.  All interventions need to take gender into account by recognizing the different socialization processes of women and men.

2.  Pay special attention to the way in which socialization processes disadvantage women.

3.  Recognize that each gender hears a different meaning in the same clinical intervention and accordingly feels either blamed or supported.

4.  Change economic, social and legal institutions to support changes that would enable women to work more outside of the home, and men to work more inside by providing child-care, and giving economic and social status to the work of child rearing. (personal is political).

Model of Family Therapy

View of Normal Family Functioning

View of Dysfunction or Symptoms

Goals of Therapy

Family Decision Making/Family Group Conference

(Maori,

Buford, Hudson, Showell)

1.  Children are best protected and nurtured when families are strong.

2.  Families have strengths and can change.

3. Families deserve respect.

4. Families, relatives and communities are allies and resources.

5. Family strengths are what ultimately resolve issues of concern.  It is important to set up opportunities for families to show their strengths.

6. The people who get most deeply impassioned about a particular case of child abuse are the parents and relatives.

1.  Ignoring customs, rituals and kinship networks increases problems rather than decreasing them.

1.  Stregthen families.

2.  Avoid out of home placements.

3.  Return children from foster care.

4.  Increase safety for children by encouraging and using the resources and strengths of the families, friends, relatives and communities themselves.