Transcript Family Therapy

Unit 9: Comparative
Psychotherapies - Seminar
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This week we read chapters 16 and
Read the following article on
Strategic Family Therapy:
National Institute on Drug Addiction (NIDA) (n.d.)
Brief strategic family therapy for adolescent drug
abuse.
Read Chapter 1 � Brief Strategic Family Therapy: An
overview Retrieved 08/12/2008 from
http://www.drugabuse.gov/txmanuals/bsft/BSFTIndex.html
Unit 9: Comparative
Psychotherapies - Seminar
Read article on principles of drug addiction
treatment:
National Institute on Drug Addiction (NIDA) (n.d.)

Principles of drug addiction treatment: A research based
guide
Read the first article, �Principles of effective treatment.�
Retrieved 08/12/2008 from
http://www.nida.nih.gov/podat/PODATIndex.html
Unit 9: Comparative
Psychotherapies - Seminar
Read Article on Dual Diagnosis:
Leshner, A. I. (1999) Drug abuse and mental disorders:
Co-morbidity is reality
NIDA Notes, Vol. 14, �Directors' Column�. Retrieved
08/12/2008 from
http://www.drugabuse.gov/NIDA_Notes/NNVol14N4/DirRe
pVol14N4.html
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Discussion Question 1
1. Treatment for addictions is most often
done in a group setting. Why do you think
this is so? What in the nature of addictive
personality or addition problems makes
group therapy a more effective treatment
venue??
Discussion Question 2
2. Strategic Family Therapy (SFT): According
to the theory of SFT, what is the cause of
the dysfunctional behavior? What are the
other fundamental assumptions of SFT
treatment?
Discussion Question 3
3. Dual Diagnosis: If your client has both an
addiction and a psychiatric problem such as
depression or bipolar disorder, which do you
treat first? Or should you treat them both
at the same time? Why? What if the client
is just trying to treat their psychiatric
problem with the drug/alcohol?
Group and Family
Therapy
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Group therapy and family therapy both
feature multiple clients being treated
together
However, they are quite distinct from
each other, with separate histories and
methods
We will consider them separately in
this chapter
Group Therapy: An
Interpersonal Emphasis
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Most forms of group therapy strongly
emphasize interpersonal interaction
– take advantage of the fact that the group
therapy experience itself is based on interacting
with other people
– Irvin Yalom is a leader in this interpersonal
approach to group therapy
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Clients’ problems stem from flawed interpersonal
relationship skills
If they can practice and improve on this with fellow
group members, they can generalize lessons learned
Therapeutic Factors in
Group Therapy
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Universality
– Clients realize that others share the same
struggles (“we’re all in the same boat”)
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Especially powerful in homogeneous groups
Group Cohesiveness
– Feelings of interconnectedness among group
members
– Trust, acceptance, belongingness
– Analogous to therapeutic alliance in individual
therapy
Therapeutic Factors in
Group Therapy (cont.)
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Interpersonal Learning
– The same interpersonal tendencies that
contributed to the client’s problems will
appear in the group context
– Group members form relationships with
each other and work to improve them,
and those improvements will help with
outside relationships eventually
Therapeutic Factors in
Group Therapy (cont.)
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Interpersonal Learning (cont.)
– The group becomes a social microcosm for each
client
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Clients enact their own relationship pathology (without
knowing it) in the group itself
– Focus on the here-and-now
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Discourage discussion of lives outside of therapy
Encourage discussion of relationships between group
members in the current moment
Clients talk directly with each other about they way
they behave toward each other
Discussion Question
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What are some potential ethical dilemmas of
group therapy? For instance, what steps, if
any, should be taken by a clinical
psychologist if two group therapy clients
begin dating? Additionally, how can a
psychologist ensure confidentiality in a
group setting?
Is confidentiality in a group setting possible?
Practical Issues in Group
Therapy
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Group membership
– Typically 5-10 clients
– Open-enrollment groups—individuals leave or
join at any time
– Closed-enrollment groups—members start and
finish together
– Most individuals can be included, unless they
can’t interact meaningfully with others and
reflect upon that interaction
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Psychosis, acute crisis, frequent absences are
problematic
Practical Issues in Group
Therapy (cont.)
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Preparing clients for group therapy
– Correct misconceptions
– Provide realistic and encouraging data
about outcome
– Encourage helpful ways of participating
Practical Issues in Group
Therapy (cont.)
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Developmental Stages of Therapy
Groups
– Initially, cautious and concerned about
acceptance
– Next, some jockeying for position in the
social “pecking order”
– Finally, cohesiveness emerges
Practical Issues in Group
Therapy (cont.)
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Cotherapists
– Often, group therapy is conducted by a team of
two therapists (rather than one)
– Second set of eyes and ears can attend to client
behaviors
– Also, therapists can model healthy interaction
– Cotherapy can be problematic when therapists
are competitive, distrustful, or have incompatible
therapy orientations
Practical Issues in Group
Therapy (cont.)
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Socializing between clients
– Extra-group socializing between clients
(romantic or platonic) is a significant
problems
– Even when prohibited at the outset, it
happens at times
– Loyalty to friendship may exceed loyalty
to group
– Other group members can feel excluded
Discussion Question
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Are closed- and open-enrollment groups
better suited for certain types of
psychological disorders? Are heterogeneous
and homogeneous groups better suited for
certain types of psychological disorders?
Do you think that the composition of a
group contributes to therapy effectiveness?
Explain your responses.
Ethical Issues in Group
Therapy
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Confidentiality
– Clients should maintain confidentiality of
fellow members, but difficult to enforce
– Consequences of broken confidentiality
can effect professional or personal life, as
well as group climate of trust
– Important to get group members to
appreciate importance of this and commit
to maintaining confidentiality at outset
Outcome Issues in Group
Therapy
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Not studied as extensively as
individual therapy
Existing studies strongly suggest that
group therapy is beneficial
– About equal to individual therapy in most
studies; slightly inferior in a few studies
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Can be less expensive than individual
therapy also
Family Therapy: The
System as the Problem
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When the family therapy movement
initially arose in the mid-1900s, it was
considered revolutionary
– Psychological symptoms were a
byproduct of dysfunctional families
– One individual may exhibit the symptoms,
but the problem actually belonged to the
entire system
Family Therapy: The System
as the Problem (cont.)
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Circular causality—events influence
each other reciprocally
– As opposed to linear causality, which is
endorsed by individual therapists
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Focus on communication patterns in
families
Focus on functionalism of symptoms
– Within family, symptoms may be adaptive
Family Therapy: The System
as the Problem (cont.)
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Homeostasis
– Families regulate themselves by returning
themselves to an emotional set point
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Like a thermostat
– A family member may sense that the
family is reaching an uncomfortable state,
and take action (feedback) to return it to
comfort zone
Assessment of Families
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Interviews and other methods as used
in individual therapy are common
Genograms
– A pencil-and-paper method of creating a
family tree that incorporates detailed
information about the relationships
between family members for at least
three generations
– Process and result can both be beneficial
Assessment of Families
(cont.)
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Family Life Cycle
– A developmental theory for families, including six
stages
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Leaving Home
Joining Through Marriage
Families with Young Children
Families with Adolescents
Launching Children and Moving On
Families in Later Life
– Can be adapted for diversity in culture,
experience, and other variables
Assessment of Families
(cont.)
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Identified patient
– It can be critical for the family therapist
to persuade the family that the problem
is systemic rather than individual
– This can be difficult when the family has
attributed the problem entirely to one
member (identified patient)
Discussion Question
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What is your opinion of the systems
approach employed by family
therapists?
Can family systems be pathological, or
is pathology only found in individuals?
Family Therapy: Essential
Classic Concepts
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Family Structure
– Unwritten rules by which a family
operates
– When flawed, problems in relationships
and individuals may result
– Family structure can be improved by
focusing on subsystems within families
and the boundaries between them
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Should be neither enmeshed nor disengaged
Family Therapy: Essential
Classic Concepts (cont.)
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Differentiation of Self
– An appropriate degree of selfdetermination, or becoming your own
person, is essential
– Families that don’t allow this to happen
can create problems for their members
– Families remain emotionally fused, or an
undifferentiated ego mass
Family Therapy: Essential
Classic Concepts (cont.)
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Triangles
– When two people are in conflict, either one may
try to bring in a third person to take their side
– In families, this can be problematic, especially
when the triangulated person is a child
– Therapeutic goal is to encourage detriangulation
and direct communication between two people
at odds with each other
Family Therapy:
Contemporary Approaches
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Solution-Focused Therapy
– Evolved from strategic family therapy
– Emphasis on solving problems
– Emphasis on the use of solution-talk rather than
problem-talk
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Make clients think about positive outcomes rather than
unpleasant present situations
– Emphasis on exceptions to current problems
(times when better) and how they created these
exceptions (to encourage them to create more
exceptions)
Family Therapy:
Contemporary Approaches
(cont.)
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Narrative Therapy
– Highlights clients’ tendencies to create meanings
about themselves and the events in their lives in
particular ways
– Stories we construct about our own lives are
powerful influences on the way we experience
new events
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We “edit” our experiences to fit the story line
– Revise stories and recast selves in more positive,
heroic way; new events can be interpreted more
positively
Ethical Issues in Family
Therapy
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Cultural competence
– Family therapists should appreciate the cultural
background of the families
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Ethnicity
Religion
Other variables
– Often, one family includes a blend of cultural
influences
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Members from different cultures
Varying levels of acculturation
Ethical Issues in Family
Therapy (cont.)
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Confidentiality
– Can be difficult when one family member tells
therapist something in private
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Diagnostic Accuracy
– DSM disorders apply to individuals, not families
– If diagnosis is required, therapist who thinks
system is flawed has a dilemma
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Labeling identified patient with disorder can perpetuate
the family’s tendency to blame one member
Outcome Issues in Family
Therapy
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Methodological difficulties in
measuring outcome of family therapy
include the issue of which family
members’ opinions should be solicited
Not as much outcome research as
individual therapy, but existing
research is very positive
– Family therapy appears to work about as
well as other modes of therapy
Discussion Question
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As a family therapist, would you allow members of
a family which you are treating to schedule
individual appointments in addition to family
sessions? If so, would information disclosed during
individual sessions remain undisclosed to other
family members, or would all information shared by
each family member be communicated to all
others?
What other difficult interpersonal dynamics might
arise in family therapy? What are some ways in
which a family therapist can address these issues?
Questions?