Category: Family Therapy

In the following essay, I have chosen to speak about the concept of engagement as I feel it is a very important aspect of family therapy if it is to be a success. In my work as a nurse in the self-harm team, looking after young people between the ages of 12-18 who are experiencing self-harm, suicidal ideation, and/or suicide attempts, I am often meeting with families in a crisis situation. This calls for a rapid engagement with the young person and their families in order to manage the crisis quickly and effectively. Such rapid engagement, often with very little information at referral poses as a challenge, with numerous barriers to developing a therapeutic relationship, especially with the young person where containment and safety is the main focus in the initial stages as opposed to trying to find ‘the problem’.

I will first consider the strengths and weaknesses of the concept of engagement and then go on to consider how this concept may have been useful when working with the family I will present, and the barriers I face that make the concept of engagement often a difficult one due to the nature of the crisis intervention work that I do.

”Engagement is a complex, reciprocal process concerning the relationship between the therapist and family. It refers to the specific adjustments the therapist makes to him/herself over time to accommodate to the particular family” (Jackson and Chable, 1985:65).

According to Flaskas (1997), this definition continued to be worth repeating due to its emphasis on engagement as a continual relational process and because it explicitly prioritizes the therapist’s use of self (268). The therapist’s use of self in family therapy has been seen as ‘the most powerful tool in the process of changing families’ (Minuchin and Fishman, 1951, Chapter 3:32).

During the early years in the development of family therapy, weaknesses of engagement theory were that there was very little emphasis on the therapeutic relationship and more on technique. For example, Sim Roy Chowdhury (2006) claimed that, during the first forty years in the development of systemic family therapy, the therapeutic relationship has not been seen as a central concern to writers (153). Early structural and strategic family therapy theory traditionally placed an emphasis on the application of technique by a therapist and a strong theoretical rationale for the development of a good therapeutic relationship was not an advanced one (154). This was further reinforced by The Milan Group who proposed that the therapist should strive for a position of neutrality (Palazoli et al.,1980 in Roy-Choudhary 2006). Such privileging of technical expertise over the therapeutic relationship led Treacher (1992) to remark that ‘major schools of family therapy are predominately scientistic and anti-humanist (26) and have failed ‘to explore how clients feel about being in family therapy(27).

During the 1980s and 1990s neutrality was reframed as a ‘state of activity, whereby the therapist’s curiosity was to maintain a respectful engagement and allow for the possibility of new types of conversations (Chechin, 1987, 1992, in Roy Choudhury, 2006:154). At this time attention was increasingly turning to the therapist and the position they may take in relation to the family.

In the earlier years, in his work on ‘joining’, Minuchin claimed that ‘the therapist must, from the beginning take some sort of leadership role’ (Minuchin and Fishman, 1951, Chapter 3:28). Alternatively, Anderson and Goolishan (1988) encouraged therapists to adopt a non-expert, ‘not knowing attitude to therapy to enable the therapist to have a respectful curiosity that would allow for new possibilities to develop in these type of therapeutic conversations. Reflexivity in the therapist began to be encouraged ( Roy-Choudhury, 2006:154).

Flaskas (1997) looked at the process of engagement as a way of exploring the therapeutic relationship, arguing for the need for a radical extension of the idea of engagement in systemic therapy and speaking of the ‘historical failure of systemic therapy to theorize engagement as a relational process and advocated for the need for the development of a much broader understanding of engagement (264).

In more recent times, Tuerk et al (2012) stated that a fundamental assumption of the new generation of evidenced-based family therapy approaches is that family engagement and collaboration are essential for therapeutic progress (168). In the 21st Century, there is less emphasis on techniques and more on the process of family therapy as a series of collaborative conversations (Dallos and Draper, 2010:245). “Collaborative relationship” refers to how we orient ourselves to be, act and respond so the other person shares the engagement and “joint action” (Shotter, 1984, in Anderson, 2012:14).

The names of the family I will discuss have been changed for reasons of confidentiality. I was asked to attend the Children’s ward to carry out an urgent risk assessment on Anna, an 11-year-old girl who had been admitted the previous evening due to suicidal ideation that her mother Jenny, had been struggling to manage. Her mum had been witnessing a significant decline in Anna’s mood for the past 12 months but in particular the past few weeks. Anna had reached a crisis point where she was having constant thoughts of not only hurting herself but other people as well. This was causing her extreme distress and she had arrived at a point where she no longer felt safe, even with her mum who was very supportive and loving. She was scared of her own thoughts, felt out of control, and needed to go to a place of safety.

Anna is an only child who lives with her mum. She had chosen to cease contact with her dad 1 year ago due to his alcoholism. She described him as ‘a rubbish dad’. She felt let down and disappointed by him and the ceasing of contact coincided with the decline of her mood.

My attendance at the ward was to establish whether Anna would be deemed mentally fit to be discharged. Having received the referral only 1 hour before, I had very limited information. Name and reason for admission, and that mum was with Anna was all I had to go by. With a routine referral I would have more information, and time to prepare, a letter would have been sent to the family and they would also have time to prepare. Attending to an urgent referral does not allow for this.

Arriving at the ward I am met with a very unhappy, sad-looking young girl who has had no sleep. Mum is clearly worried about her daughter. On reflection, I realize they have expectations of me before I have arrived. They have been told Anna cannot go home unless I say so. Does Anna want to go home and does mum want her home? Does Anna have the expectation that I will help her feel better? My agenda is one of containment and safety, and I have to build an instant rapport with them both to complete the assessment. This inevitably means that no matter what the ‘problem’ is, it will not get addressed in this appointment and this often leaves the young person feeling unheard. From the moment I arrived, it was clear that Anna did not want to go home. She was distressed and agitated but she did not warrant admission to a psychiatric unit and this would have been no benefit to her. She was telling me she was very scared of her thoughts and worried she would hurt her mum. Despite this, she was mentally fit to go home.

I remember thinking that Anna was telling me her story, and how she felt, and I could feel her level of distress, but I was the one making the decision to send her home. She did not feel listened to and told me that herself. I was engaging with Anna from what felt like a position of authority, a leadership position like Munichin (1951) suggested was necessary from the beginning (28). I felt uncomfortable with this. Immediately Anna does not trust me, I imagine she must feel her voice isn’t heard and I can understand why. I cannot admit her to a psychiatric unit, my hands are tied, and the relationship between me and Anna is already broken.

Mum, on the other hand, is coming from a position where she desperately wants her daughter home. She knows her daughter is safe with her and she is getting what she wants. I can imagine that she feels heard. Despite both mine and Jenny’s attempts to get Anna to believe that she will be safe at home, her distress is stopping her from doing so. I wondered whether she felt ‘ganged up on by us. I was in a position where I was agreeing with her mum and disagreeing with Anna’s wishes.

I was able to build a rapport with mum only. The position of neutrality was not an option and usually never is under these circumstances. I found myself thinking about the endless barriers to building a therapeutic relationship with young people in these circumstances and whether it was even possible when that person’s problems are seeming to be disregarded in place of safety and containment.

An even bigger barrier to engaging Anna and having any therapeutic relationship develop is the safety plan I discuss with mum. Constant supervision, removal of phone, bedroom door being left open, no privacy. I wonder if Anna feels I am punishing her for feeling suicidal? Again Anna was distressed by this, not only was I sending her home, I was placing sanctions on her for her safety. I remember feeling how task orientated the nature of my job is. I wondered whether there could be another way of working to help young people in this situation have more of a voice and therefore allow for a better engagement when they come to see me in a clinic for their follow-up appointments.

This got me thinking about the difficulty in this situation of working collaboratively with all members of the family. Tuerk et al (2012) looked at engagement and collaboration strategies that have empirical support in helping young people and their families experiencing serious behavioral problems. They identified a number of successful strategies including reflective listening, empathy, hope and reinforcement, authenticity, and flexibility. When reflecting on my engagement with Anna and Jenny, I realized that it would look as though I had been working collaboratively with mum and the ward staff, but not necessarily Anna. For example, reflective listening requires the therapist to be able to summarize both the content and meaning of the conversation in a way that feels supportive to the client (Tuerk et al, 2012:170). In this case, I was listening to Anna, reflecting back to her that I understood her reasons for being in the ward, but I wondered whether she would view this as me being supportive in any way. Mum on the other hand, I felt I was working with, rather than against, as Anna may have seen it. How could Anna possibly see me as working with her, having a collaborative conversation, when I was unable to grant her wish of not wanting to go home?

Rogers (1959) wrote of the importance of empathy cutting across schools of psychotherapy and that to maintain an empathic viewpoint therapists need to demonstrate an ‘intimate understanding of the clients perspective, as though they themselves were experiencing the client’s thoughts and feelings (in Tuerk et al 2012:170). On reflection, I wondered whether Jenny had felt I was being empathic towards her. I was able to offer her reassurance that she was acting in the best interests of Anna, able to console her when she was upset. As a mother myself, I could see things from her perspective and relate to her in terms of her wishes for her daughter. But again I imagined that Anna would not feel any empathy from me even though I believe I was offering it to her. Her young age would mean she could not understand that I was doing what was best for her and not admitting her to a psychiatric unit which I knew would only cause her more distress.

The situation meant I had to be authentic. Being authentic means striving to communicate in ways that are honest and consistent (Tuerk et al, 2012:172). Dallos and Draper (2010) state that for both the therapist and the family, thinking and formulation are more productive, free, and creative when there is a sense of trust and a mutually secure base or sense of safety. They argue that there is no magic recipe for doing this and that an attempt to be honest and authentic is important (158). My engagement with Anna and Jenny I believe was an honest one but on reflection, I wondered whether Anna could appreciate my honesty in any way. She appeared not to trust me, she was telling me she didn’t feel safe, both crucial to an effective therapeutic relationship. I was giving Anna the message that if she was not discharged that day from the Children’s ward, where I knew she felt safe, she would be unable to stay on there and she would be admitted to a psychiatric ward. I was honest with her about what this experience may be like for her and that I felt she would feel less safe there and much safer at home with mum. While I was being honest, I felt as though Anna must be thinking I was not telling the truth and merely saying this in order to discharge her. I had the sense that mum was appreciating me being honest with Anna about what a psychiatric ward may be like and that my authenticity was helping her with what she wanted for her daughter.

Rober & De Haene (2017) looked at Derrida’s concept of hospitality. This concept has been proposed by some authors as an interesting tool to enable reflection on the therapeutic relationship as an ethical relationship whereby the therapist develops a welcoming openness to the client. (378).

Anderson (2012) spoke of mutual inquiry, Mutual inquiry involves ‘an in-there-together process in which two or more people put their heads together to address the reason for the conversation’. In order to set the stage for mutual inquiry, a therapist should be both hospitable and open to learning. The therapist, therefore, becomes both hospitable host and guest at the same time. The ‘host–guest’ metaphor emphasizes the notion that a client is like a foreigner coming to a strange land and the importance of being courteous, sensitive to their uneasiness, and careful to not intrude. Said simply, it is about being mannerly and creating a companionship-like relationship (15-16).

When thinking of about coming from a position of hospitality like this I reflected on how both Anna and Jenny may have perceived me coming to the ward to meet them, and how I viewed myself. Unlike in my clinic, where I view myself as being the host, welcoming families I have had time to prepare for into my office, I very much viewed myself as being the guest in this situation. I had arrived in Anna’s ‘home’ for the night, the hospital bay, where she was feeling safe.

Jenny was very welcoming to me, relieved to see me, and I imagined she would be seeing me both as guest and host. This led to a good engagement with her from the start. Alternatively I was curious as to whether Anna viewed me as an unwelcome guest. This may not have been her immediate perception of me but I imagined that once she had realised I was sending her home she may have seen me as the ‘intruder’, coming into her space, a now uninvited guest. The nature of this kind of assessment makes it hard for me to be the host. Often families can be hostile towards me on my arrival to the ward as they have been waiting for a long time, often feeling distressed about the events that have led them to be there. I imagine for a lot of families I am seen as an unwelcome but necessary guest who they have no option but to engage with. This does not always make for the foundation of a good therapeutic relationship.

Rober and De Haene (2017) argued that the concept of hospitality invites therapists to accept the complexity of therapeutic responsibility in being a supportive presence that necessarily and simultaneously involves the ‘violence’ of appropriation and power difference (380). Derrida used the term ‘violence’ in the therapeutic relationship to mean something that is subtle and unintended and an inevitable part of the encounter between the therapist and client (in Rober and De Haene, 2017:380). When thinking about my own engagement in particular with Anna, the ‘violence’ in the relationship may be seen as me coming from a position of power.

This may have looked intentional to Anna when it is not intentional on my part through choice, my job was to engage her as best I could in the time I had and ensure her safety and containment in the days ahead. As much as I do not want to in these circumstances I have no choice but to use my ‘power’ to discharge patients like Anna.

This has led me to reflect recently on this being a part of my job I feel powerless to change. I would like to be able to give Anna and other patients what they feel they need to help them when they are feeling very distressed but currently I am unable to do so. As a result this often impacts on the relationship I have with them when they come to see me in the clinic the following week for review.

In conclusion, good engagement is fundamental to the therapeutic relationship. Early engagement theories focused on technique and the therapist taking various positions such as one of the leaders or one of neutrality. Engagement theory in more recent times increasingly emphasizes the therapeutic relationship as being central to good engagement with families in order for therapy to be successful. This focuses on a collaborative approach, with all members of the family being involved and heard, and the therapist coming from a position of hospitality where they are open, welcoming, empathic, and most of all authentic.

My reflections on my first encounter with Anna and Jenny have enabled me to think about how difficult it can be in my role to establish a therapeutic relationship with all involved, during a time of crisis and whether a good engagement with the young person in these situations can ever really be achieved and what measures could be put in place, if any, to change this and be able to work in a different way. I am still considering the answers, if there are any, to this question.

References:

1. Anderson, H. (2012) Collaborative Relationships and Dialogic Conversations: Ideas for a Relationally Responsive Practice. Family Process. 51(1): 8-24.
2. Choudary, S.R (2006) How is The Therapeutic Relationship Talked into Being? Journal of Family Therapy, 28: 153-174.
3. Dallos R; Draper, R (2010) An Introduction To Family Therapy 3rd Edition. Berkshire, OU Press.
4. Flaskas, C. (1997) Engagement and The Therapeutic Relationship in Systemic Therapy. Journal of Family Therapy, 19:263-282.
5. Jackson, S; Chable, D.G (1985) Engagement:a Critical Aspect of Family Therapy Practice. Australian and New Zealand Journal of Family Therapy, 6:65-69.
6. Minuchin, S; & Fishman, C.H (1981) Family Therapy Techniques. Harvard University Press, 1981. Cited at ProQuest Ebook Central, https://ebookcentral.proquest.com/lib/nhsscotland-ebooks/detail.action?docID=3300755.
7. Rober, P; De Haene, L. (2017) Hopsitality in Family Therapy Practice: A Further Engagement with Jacques Derrida. Australian and New Zealand Journal of Family Therapy, 38:378-390.
8. Treacher, A (1992) Family Therapy-Developing a User Friendly Approach. Clinical Psychology Forum,48:26-30.
9. Tuerk, E.H; McCart, M.R; Henggeler,S,W (2012) Collaboration in Family Therapy. Journal of Clinical Psychology,68(2):168-178.

As one evolves throughout their career as a therapist, they may decide to work with clients individually as well as with the individual and their family. Understanding and know the different types of theories and techniques utilized in family therapy will help a professional in the mental health field be an effective therapist. A few theories that one may benefit in knowing and should be familiar with are Strategic, Structural, and Milan Systemic family theories. It is also necessary for a professional to distinguish who the major contributors are for each theory, the history of the theory, interventions used for each theory, the similarities and differences of each theory as well as a possible contributor of a specific theory one may want to model.

Major Contributors

A few major contributors to Strategic family therapy are Milton Erickson, Gregory Bateson, Jay Haley, John Weakland, and Don Jackson (Nichols & Davis, 2017). Structural Family therapy’s major contributors are Salvador Minuchin, Braulio Montalvo, Jay Haley, Bernice Rosman, Harry Aponte, Carter Umbarger, Marianne Walters, Charles Fishman, Cloe Madanes, and Stephen Greenstein (Nichols & Davis, 2017). The major contributors to Milan Systemic Family therapy are Mara Selvini Palazzoli and Guiliana Prata (Nichols & Davis, 2017).

The History

It is essential to understand the history of each approach as one begins to choose an appropriate theoretical style. Strategic family therapy is based on communications theory. Communication theory is the study of relationships and how verbal and nonverbal messages are exchanged (Nichols & Davis, 2017). Communications theory was established during Bateson’s schizophrenia project. In 1952, Bateson was given a grant and invited Haley, Weakland, and Jackson to study the paradox in communication in Palo Alto (Nichols & Davis, 2017). They concluded that the exchange of complex communications between people explains their relationship. In 1959, Don Jackson founded the Mental Research Institute (MRI), where the founders of Bateson’s schizophrenia project developed three different models. These models were MRI’s brief therapy, Haley and Madanes’ strategic therapy, and finally the Milan systemic model (Nichols & Davis, 2017).

The MRI brief therapy approach is centered on identifying and interrupting ironic processes that occur when repeated attempts to solve a problem keep the problem going and making it worse (Nichols & Davis, 2017). The Haley and Madanes strategic approach was influenced by Erikson, Bateson, and Minuchin. Erikson assumed the unconscious was filled with knowledge and that he specifically did not need to offer individuals insight, but to provide assistance in aiding them in accessing insight on their own (Nichols & Davis, 2017).

Salvador Minuchin was one of the major contributors to structural family therapy (Nichols & Davis, 2017). Minuchin was a physician in the Israeli army and was born and raised in Argentina. When he arrived in the United States, he began training in child psychiatry and started working with and training Nathan Ackerman. Minuchin later returned to Israel and began working with displaced children (Nichols & Davis, 2017). In 1954, he returned to the United States, where he engaged in psychoanalytic training at William Alanson White Institute. In 1962, Minuchin was at Palo Alto and met Jay Haley and by 1965, he became the director of Philadelphia Child Guidance Clinic. Minuchin’s associates in Philadelphia were Braulio Montalvo, Jay Haley, Bernice Rosman, Harry Aponte, Carter Umbarger, Marianne Walters, Charles Fishman, Cloe Madanes, and Stephen Greenstein and were all contributors to the development of structural family therapy (Nichols & Davis, 2017). There are three structures that define structural theory, which are structure, subsystems, and boundaries. Structural therapy addresses patterns of interaction that create problems within families. Mental health concerns are often perceived as signs of a dysfunctional family (Nichols & Davis, 2017). In Structural family therapy, the goal of treatment is adjusting the family structure instead of modifying the individual family members (Nichols & Tafuri, 2013). By the 1970s, structural family therapy had become the most widely practiced approach of family therapy (Nichols & Davis, 2017).

The Milan systemic family therapy approach was first presented by a group of family therapists, who were working with Mara Selvini Palazzoli and developed her own approach to family therapy (Lorås, Bertrando & Ness, 2017). By 1967, she managed a group of eight psychiatrists and formed the Center for the Study of the Family in Milan, where they developed the Milan systemic model (Lorås, Bertrando & Ness, 2017). The team utilized cybernetic systems and saw that irrational behavior was a result of people being isolated in their struggles and unable to maintain certain relationships within the family. The main goal of this therapy was to establish a change in interaction patterns between members of the system. This was achieved by reframing, use of circular questions, and the therapist practicing neutrality (Lorås, Bertrando & Ness, 2017).

Specific Interventions Used

Specific interventions used in strategic family therapy come from the MRI Approach, The Haley and Madanes Approach, and the Milan Model. Interventions that involve the MRI Approach are reframing, paradoxical interventions, symptom prescriptions, and restraining techniques (Nichols & Davis, 2017). An intervention used in the Haley and Madanes Approach is the use of directives. Directives are utilized to establish relationships as well as bring change, they can be straightforward and/or indirect (Nichols & Davis, 2017). Positive connotations and rituals are interventions used in the Milan Model. Interventions used in structural family therapy are joining and accommodating, enactment, structural mapping, highlighting and modifying interactions, boundary making, unbalancing, and challenging unproductive assumptions (Nichols & Davis, 2017). An example of joining and accommodating in structural therapy would be for the therapist to build a therapeutic alliance to establish a bond so they are able to join the family in therapy, which can aid in members from resisting the therapeutic process.

Similarities and Differences

Understanding the similarities and differences of each approach can help the therapist determine what model or combination of models are best to practice and what is best for the family system. Strategic, structural, and Milan systemic approaches integrate from a systems approach (Darwiche & Roten, 2015). Strategic and structural models highlight understanding and treatment of dysfunction in family communications and interpersonal relationships that aid in significant difficulties (Darwiche & Roten, 2015). The structural family theory emphasizes in changing the structure of a dysfunctional family and by doing this will allow the family to interact in a positive way and identify the dysfunctional patterns (Nichols & Davis, 2017). In structural family therapy, treatment is initiated with joining, accommodating, testing boundaries, and restructuring. Strategic family theory concentrates on the family system and their interactions with a problem instead of recognizing the problem (Nichols & Davis, 2017).

A Major Contributor to Model

A major contributor that one may choose to model when providing system work is Salvador Minuchin. Minchin’s major concepts of structural family therapy highlight a systemic and structural process. The therapist begins to examine the family structure in order to determine how the family’s interactions created dysfunction within family. The advancement of research and knowledge indicates how the development of structural family therapy assists the therapist in recognizing how interpersonal problems affect areas the family. As one gains knowledge about family systems, they may consider that an individual’s behavior are a function of their relationship with others. One following in the footsteps of Minuchin may believe that the primary goal is to aid families in addressing dysfunction and bring the household back to homeostasis.

Conclusion

Being able to understand the different approaches and theories of family therapy is essential in establishing competency as a family therapist. Understanding the similarities and differences of each approach is a key to choosing which theory would be appropriate to use or would benefit the family system. Utilizing empirical research and comprehending each theory will help an individual to develop into an effective therapist.

References

1. Darwiche, J., & Roten, Y. (2015). A couple and Family Treatments: Study Quality and Level of Evidence. Family Process, 54(1), 138–159. https://doi.org/10.1111/famp.12106
2. Lorås, L., Bertrando, P., & Ness, O. (2017). Researching Systemic Therapy History: In Search of a Definition. Journal of Family Psychotherapy, 28(2), 134–149. https://doi.org/10.1080/08975353.2017.1285656
3. Nichols, M., & Tafuri, S. (2013). Techniques of Structural Family Assessment: A Qualitative Analysis of How Experts Promote a Systemic Perspective. Family Process, 52(2), 207–215. https://doi.org/10.1111/famp.12025
4. Nichols, M. P. & Davis, S. D. (2017). Family therapy: Concepts and methods (11th ed.). Upper Saddle River, NJ: Pearson Education, Inc.

Abstract

When approaching the idea of family counseling, one must decide which approach would be best to recommend as well as an implement with clients. The structural model approach is a unique approach to counseling and is all about organization, family rules, and roles. Using this approach is about focusing on the constructs of the family and identifying solutions based on subsystems, boundaries, and organizational metaphors. This approach identifies functional and dysfunctional patterns through how the family responds to its underlying organizational structure and flexibility in responding to the many changes that occur around it. In its onset, the structural approach helped to change the way in which the family unit and its members were perceived within the mental health field. It was because of this change that the structural approach has been highly regarded within the family therapy experience allowing both the family and the therapist to develop ways in which the family can function that is beneficial to all its members. Also included is a personal integration focusing on the intersection where Christ-centered therapy and Structural Family Therapy meet.

Family Counseling Approach Research Paper: Structural Family Therapy

Part I

How families adapt to change as well as how they interact with each other can be what causes the family to function well or suffer from dysfunction. Structural Family Therapy (SFT), is an approach that focuses on the treatment of familial patterns and interactions as well as mental health issues. Issues such as this are seen as dysfunctional and are treated by viewing the family unit as a whole. SFT doesn’t focus on the members as individuals (Goldenberg, Stanton, & Goldenberg, 2017). When families receive structure-based therapy one of the main goals is to improve interactions and communication between the family members, as well as introduce boundaries and create a family structure that is healthy for everyone involved. What leading figures focused on when creating this approach was the wholeness of the family, the influence of the familial hierarchical organization, and the inter-reliant functioning of the family’s subsystems (Lindblad-Goldberg, & Northey Jr, 2013). This can be an effective approach for all types of families including extended families, blended families, as well as single-parent families.

The founding of SFT historically was intended to address the distress we have with and within our families as well as the dilemmas in relation to our family dynamics. The only way to truly understand this distress in an individual is to understand the context of the relationships where it arises, such as the family (McAdams III, Avadhanam, Foster, Harris, Javaheri, Kim, Williams, 2016). The same problems that sparked the creation of this technique, we still face today. Families will continue to need structural-based therapy to help identify distress among family members. When using SFT the family is seen as a psychosocial system that functions through patterns. These subsystems may have no boundaries. In order for SFT to be successful, therapists need to help the family to work towards forming a new system within the family group as well as help the family to make changes within the structure (Goldenberg, Stanton, & Goldenberg, 2017). Therapists have learned that joining the family unit is important to therapy success. Therapists must be unbiased in this process; it is important not to take sides, but instead to be a mediator between the “sides”. Individuals currently deal with broken family units and unhealthy familial boundaries, and this will continue until the Lord returns. In the same way, children are and will continue to suffer from disorders that have been linked to familial structure such as depression, asthma, anxiety, diabetes, anorexia, bulimia, and more. Even adults benefit from this therapy because adults are suffering from distress as well. SFT is beneficial because it gives the entire family the opportunity to be assessed and work towards the changes that need to take place for the family members to function at a healthy level. A goal is for families to learn to cope and deal with changes and distress in ways that do not isolate members or cause further damage to members.

Salvador Munich was a prominent leading figure in the founding of SFT. Minuchin was a psychiatrist in the 1960s; he began his work with you in New York that showed signs of being troubled. He started out as a doctor in the military; he seemed to always have a love and passion for working with children (Goldenberg, Stanton, & Goldenberg, 2017). He became interested in studying the familial structure upon working with so many children that had problems he felt were created from the family structure. He began working to create ways to help these students which led to developing a theory as well as a specific intervention technique. Minuchin even reached out to different professionals from different disciplines to help him form structural therapy into what he knew it could be. With the help of his team, Minuchin was able to offer family therapy to families. One of the biggest attention grabbers for Minuchin was psychosomatic conditions within families; he really wanted to focus on urgent medical problems like diabetes and anorexia, where no medical explanations could be found. This led Minuchin and his colleagues to understand that when subsystems are functioning poorly, and boundaries are not strict, it does not allow individual autonomy.

The need to restructure families in low-income areas, specifically African-American and Latino-American adolescents, on the outskirts of the New York City area around the late 1950s and early 1960s gave rise to SFT (Goldenberg, Stanton, & Goldenberg, 2017). The focus of SFT is the ability to actively strive for organizational changes within the dysfunctional family, presuming the individual behavioral changes and symptom reduction follow while the context for family transactions continues (Goldenberg, Stanton, & Goldenberg, 2017). Minuchin became fueled by an article written by Don Jackson in 1959, and he began to look at primarily low-income African-American and Latino-American adolescents in the New York City area. He then began to analyze their families, specifically their family dynamics. Along with his team at Wiltwych School for delinquent youth, Minuchin began composing brief, direct, concrete, action-oriented, and problem-solving intervention procedures to instill change by restricting the entire family (Goldenberg, Stanton, & Goldenberg, 2017). His team consisted of Charles Fishman a psychiatrist, Harry Aponte a social worker, and Marion Goldberg a psychologist. Minuchin began working to include working-class families as well as middle-class families in 1965. Later Minuchin took on the directorship of the Philadelphia Child Guidance Center (Goldenberg, Stanton, & Goldenberg, 2017).

Structural family therapy is a culmination of both theory and techniques that focus on individuals in their social and relational contexts to their families. Therapists who use this technique, assess and explore the family’s structure including, subsystems, boundaries, relationships, and support (Reiter, 2016). They use this assessment to recognize areas of strength and resilience, possible flexibility, and change. It was developed in the context of therapeutic work with families and young children. The structural approach assumes families and family members are subject to inner pressures coming from developmental changes within its own family members and subsystems and to outer pressures coming from demands to accommodate to the significant social institutions that have an impact on family members. Development on how family feedback mechanisms work and how dysfunctional communication patterns develop are what drive this theory even today. How a family copes and adapts to changes really affects members individually and can alter the way that they cope with changes in their individual lives creating distress and medical disorders (Negash, & Morgan, 2016).

According to Aponte and Van Deusen (1981), the structural approach to family therapy devises families as systems and subsystems, roles and rules, boundaries, power, and hierarchy. For example, a functional family is one in which there are clear boundaries between each individual person and the subsystems (Navarre, 1998). Figley and Nelson (1990) made mention that a functional family facilitates individual growth, prevents intrusion, promotes generational hierarchies, and provides flexible rules and roles which are adaptable to the internal and external changes of an evolving family. Minuchin (1974) noted that functional families possess well-organized boundaries. Boundaries are a family’s checks and balances. For married couples, they tend to have closed boundaries to protect their spouse’s privacy. For parents, the boundaries between parent and children must be clear and remain penetrable to ensure parenting is in the best interest of both the children and the parents.

Boundaries do not stop there, siblings have boundaries as well. The boundary surrounding the nuclear family is also one to be respected (Navarre, 1998). Structural family therapy has techniques within the approach that produce structure and change within the family system These techniques include joining, enactment, reframing, and unbalancing (Goldenberg, Stanton, & Goldenberg, 2017). Each of these techniques allows the therapeutic experience to provide respect to the family boundaries while instilling the subsystems necessary for adaptation to change and structure. Structural family therapy offers two things, a theoretical framework for describing the family organization, and a set of techniques to allow for restructuring problematic patterns (Minuchin & Fishman, 1981). It is the change and the new way of living within the family that makes the techniques of structural family therapy stand out from all the rest.

Unique Techniques

There have been numerous reports of research that support that structural family research is effective in many different populations and works for various problems as well. A recent study showed the effectiveness of using SFT techniques on children with acute illnesses such as leukemia and how it enhanced their coping skills as well as their overall mental state.

Dysfunctional families and distressed children are always the focus of the ones who benefit the most from using this technique. Parent-child boundaries and interactions are the main focal point for therapists, and they work to ensure that these boundaries are healthy, coping skills that are effective, and a family structure that allows the family to thrive (Reiter, 2016).

There has also been a study that has shown this technique being used on adolescents who need help resolving externalizing problems or things such as pornography addiction (Goldenberg, Stanton, & Goldenberg, 2017). Infidelity and how it harms the nuclear family have also shown promise. Therapists seek to find better adaptable ways to maintain the family structure and minimize the harmful impact that infidelity has on the family system (Negash, & Morgan, 2016).

Part II. Personal Integration

“How good and pleasant it is when God’s people live together in unity” (Psalm 133:1, NIV). The family unit is so important because it is the first structure that we are introduced to. We do not get to choose what family we are born into, and the structure and value system of our families affect our lives for the remainder of our lives. Families affect the way that we cope, make decisions, as well as communicate. Integrating Christianity into family counseling is definitely a priority. When God created the world, one thing he noticed from the beginning was the loneliness of man. God not only made a woman for a man, he made a woman from a man. Genesis 2:22 (NIV) reads, “Then the Lord God made a woman from the rib he had taken out of the man, and he brought her to the man”. God also made it possible for man and woman to have children. Proverbs 127:3 (NIV) reads, “Children are a heritage from the Lord, offspring a reward from him”. The foundation of the family is one of the many rewards that the Lord as afforded to us. What a shame it would be for us to not include the Lord in the family dynamics.

The Bible holds the most fundamental tools of principle related to child-rearing and the roles of parent and child. It is the bible’s truths that teach us it takes a village to raise a child. It is the bible that teaches us, “Children, obey your parents in the Lord, for this is right. Honor your father and mother” and in return “Fathers, do not exasperate your children; instead, bring them up in the training and instruction of the Lord” (Ephesians 6:1-4, NIV).It is also the bible that teaches us about love, honor, respect, forgiveness, and brotherhood. These are all key attributes in which the therapist provides to families in the SFT approach.

We learn many of our basic skills by watching how our families interact and deal with stressful situations. Many people feel if they can separate themselves from their families and the dysfunction their stress will disappear. The problem with this idea is that we still carry that dysfunction with us, and without therapy and guidance, we can just begin embedding that same dysfunction into our created families.

Many people say that the most important things in life are family and love. Sometimes this concept is a little hard to accept when we are raised in a dysfunctional family that is lacking in love. I can really relate to this technique, and I honestly feel that my family would benefit greatly from group family therapy. Some of us have gotten therapy separately, but it does not help when there are issues we need to discuss as a family. I have been the person to separate myself from my family because the dysfunction was overwhelming. I can still communicate with them and love them, but actually living near them would be greatly difficult. I can see how our dysfunctional family system has affected individuals, and they are not able to cope or create functional lives because our family system is so broken.

We as therapists should not be afraid to offer Christ-centered therapy incorporated with SFT to our clients during their time of healing. I feel it is our duty to provide the best possible service; that does and always will include God. I feel I would be able to use this technique because I understand this technique and how boundaries within families are important. I believe this technique can be effective for children, adolescents, as well as adults. All parts of the familial system are affected and can benefit. Children are easier to guide and mold, but there are adults that are still suffering from dysfunctional family systems as well.

For those clients that have other religious beliefs, we are to respect their chosen way of worship and forgo offering Christianity in the therapeutic experience. The last thing we want as therapists is to offend our clients while we are supposed to be helping our clients work towards healing. If you have a client who has no religious beliefs, however, they may have a skewed view of Christianity, this is where the therapist can assist with shedding new light on Christianity for the client. We as therapists need to be very mindful that we are not there to be a pastor for the client, but we can show the true love and beauty that the Lord has in store for the client. If you have a client that is totally against Christianity being a part of the therapeutic experience, we should not press the issue. It is not our job to make our clients do something they do not want to do; we are to respect their request and continue to offer the best therapeutic experience we can.

Integration of Christ-centered therapy and SFT or any therapy technique can be difficult. It is important that we rely on Christ to lead us through this. He knows every step we take and breath we breathe. He knows exactly what our client needs, so why would we not rely on him to lead us in our leading our client to healing? Integration has shown to be one of the most life-changing experiences for clients, so how much more powerful could it be if we allow God to take the lead in our therapy sessions and process? Allowing clients to use prayer, meditation, and scripture reading during this time opens the doors for not just mental healing but spiritual healing as well. Things like forgiveness and empathy tend to be among the many things that integrating Christianity can help clients to achieve. As the therapist, we must lean on God for guidance when and how to integrate Christ-centered therapy with SFT.

References

1. Aponte, H. J. (8). Van Deusen. JM (1981). Structural family therapy. Handbook of family therapy, 1.
2. Figley, C. R., & Nelson, T. S. (1990). Basic family therapy skills II: Structural family therapy Journal of Marital and Family Therapy, 16(3), 225-239.
3. Goldenberg, I., Stanton, M., & Goldenberg, H. (2017). Family therapy: An overview. (9th ed.). Boston, MA: Cengage Learning. ISBN: 9781305092969.
4. Lindblad-Goldberg, M., & Northey Jr, W. F. (2013). Ecosystemic structural family therapy: Theoretical and clinical foundations. Contemporary Family Therapy, 35(1), 147-160. doi:10.1007/s10591-012-9224-4
5. McAdams III, C. R., Avadhanam, R., Foster, V. A., Harris, P. N., Javaheri, A., Kim, S., . . . Williams, A. E. (2016). The viability of structural family therapy in the twenty-first century: An analysis of key indicators. Contemporary Family Therapy, 38(3), 255-261. doi:10.1007/s10591-016-9383-9
6. Minuchin, S. (1974). Families and family therapy. Harvard University Press.
7. Negash, S., & Morgan, M. L. (2016). A family affair: Examining the impact of parental infidelity on children using a structural family therapy framework. Contemporary Family Therapy, 38(2), 198-209. doi:10.1007/s10591-015-9364-4
8. Navarre, S. E. (1998). Salvador Minuchin’s structural family therapy and its application to multicultural family systems. Issues in mental health nursing, 19(6), 557-570. doi: 10.1080/016128498248845
9. Reiter, M. D. (2016). A quick guide to case conceptualization in structural family therapy. Journal of Systemic Therapies, 35(2), 25-37. doi:10.1521/jsyt.2016.35.2.25

Family Counseling Approach Research Paper

Abstract

This research intends to identify leading figures, historical and current events, assumptions, development of the theory, concepts, and techniques related to Structural Theory. It will describe how integrating biblical scriptures and the writer’s own faith and family counseling approach to help the family that is in need. In the writing, the intent is to demonstrate the knowledge, concepts, and family approach to this theory and how it relates to other leading theories that are being used in the counseling field. This research is in two parts; part one will show the historical content; part two will show the reflections and interpretation. It will show a Christian view of the concepts related to Structural Theory.

Part I. Introduction

Structural family therapy is characterized by the emphasis on family structure and organization (McNeil, Herschberger, & Nedela, 2013). Systems theory is a broad term in common use, incorporating general systems theory and cybernetic, referring to the view of networking units or elements making up the organized whole (Goldenberg, Stanton, & Goldenberg, 2017). In this research, the intent is to demonstrate the knowledge of structural theory in history and the present, exploring the different techniques, concepts, and assumptions.

Structural theory can be applied to any family, but the healing process for the Turner family is the best fit. When conceptualizing the family as a part, the relationship of the family with other parts such as the community, peers, and socioeconomic status are important for intervention (McNeil, Herschberger, & Nedela, 2013). The theory has three main parts: the wholeness of the family system, the influence of the family’s hierarchical organization, and the interdependent functioning of its subsystems (Goldenberg et. al., 2017).

History

Salvador Minuchin is a leading figure in the Structural Model (Goldenberg et. al., 2017). He was raised in Argentina by European immigrant parents (Goldenberg et. al., 2017). He worked in the United States for about 18 months doing training as a child psychologist, then returned to Israel to work with victims of the Holocaust (Goldenberg et. al., 2017). Structural family therapy came to the forefront of family therapy during a period of research and emphasis over theory when Minuchin’s Wltwuych School Project became a groundbreaking study of inner-city slum families (Goldenberg et. al., 2017). Therapists such as Bowen, Satir, Haley, and Minuchin recognized that individuals were best understood in the context of their families and systems (Rockinson-Szapkiw, Payne, & West, 2011). In structural family therapy, it focuses on the entire family system and how it functions as a whole and its subsystems all working together. The family system may or may not be effective for bringing positive things into the family, but the system works for each individual family as a way of functioning.

The approach that was developed, structural family therapy, is realistic and oriented toward problem resolution (Goldenberg et. al., 2017). Therapists and different professional that were allowed to help in treating the family was prevalent in the 1960s. Minuchin challenged the current norms when he brought the whole family into the session (Rockinson-Szapkiw, Payne, & West, 2011). Other leading figure in Structural Theory is Dr. Charles Fishman, harry Aponte, and Lindblad-Goldberg, who are from Philadelphia. They worked with families around the world with economically needy families (Goldenberg et. al., 2017). For example, the families that are in Russia on the countryside. They would work with low-income families to show them different ways to cope with their current situations.

According to Minuchin (1985), the major principles of systems theory are 1) any system is an organized whole; objects within the system are necessarily independent; 2) the whole is greater than the sum of its parts; 3) systems are composed of subsystems; 4) patterns in a system are circular rather than linear; 5) complex systems are composed of subsystems; 6) systems are homeostatic mechanisms that maintain the stability of their patterns; 7) evolution and change are inherent in open systems. When therapists are using this theory and therapy, it is important to note that systems affect people in all areas. In his work as a therapist, Minuchin took the responsibility to strengthen the family system, to develop appropriate family boundaries, and to modify family dysfunction by utilizing restructuring techniques such as joining the family, observing the ways families relate to each other, and the therapist, and challenging their functioning in insightful, innovative ways (Rockinson-Szapkiw, Payne, & West, 2011).

The family is a system linked with other subsystems that can be the community, other parts of the family, and the basics in family life. Minuchin believed that his role was to be ‘‘responsible’’ in the therapeutic change process and he also encouraged others to be responsible (Rockinson-Szapkiw, et. al., 2011). This is important to note because the family hierarchy is who is responsible. If the hierarchy does not take the role to be responsible, then the family could be doomed.

Structural models emphasize the contest of the family and use spatial and organizational comparisons to define problems and detect solutions (Goldenberg et. al., 2017). Structural therapy is one of the formative models of family therapy (Wycoff, & Cameron, 2000). It helped pave the way for other family theories to exist with its groundbreaking studies. It approaches all human behavior with the intent of identifying the dealings that normalize human relationships. (Wycoff, & Cameron, 2000). The structural theory focuses on the relationships in the family setting.

When working with families, different interventions will work using this model. The major determinants of the structural theory are the wholeness of the family system, the influence of the family’s hierarchical organization, and the interdependent functioning of its subsystems (Goldenberg et. al., 2017). The different factors of this theory are operational rules, defining boundaries, the complementarity of functions, and identifying some subsystems just to name a few (Goldenberg et. al., 2017). Clearly defined boundaries between subsystems help maintain separateness and at the same time emphasize belongingness to the overall family system (Goldenberg et. al., 2017). Defining roles in therapy helps to uncover things during sessions such as overinvolved members of a subsystem, and helps create boundaries to help improve the family system. When a family presents to therapy with concerns about their child’s behavior, the therapist can use a structural therapeutic intervention at the levels of the family and at the macro system (McNeil et. al., 2013). The structural theory will work just as any other theory would, but the success depends on how the therapist or counselor uses the therapeutic processes and interventions. The effectiveness of any theory-based treatment model depends on the adherence and quality of the nonspecific therapeutic processes (Sheehan, & Friedlander, 2015).

Some of the interventions used in therapy are structural mapping, unbalance, challenging unproductive assumptions, join and accommodating, and raise awareness so that the system must change (Goldenberg et. al., 2017). Identifying boundaries such as sibling subsystems or parental subsystem help with several areas of family dysfunction. Family systems use power, alignments, and coalitions to make family activities familiar and can be defining to the system.

When therapists or counselors use this type of theory, they join a family system and accommodate to its affective style (Goldenberg et. al., 2017). This is the beginning stage for the therapist to learn about how that particular system works and how they interact with one another. The therapist is observing, listening, and distinguishing different things about the family so that recommendations or modifications can be made by the family. This also allows the family to see that the therapist is a willing outside person looking in and becomes somewhat a part of the family with them.

A core assumption of his Structural Family Therapy is that individuals are viewed within the context of their family; families are viewed within the context of their community (Rockinson-Szapkiw, et. al., 2011). What happens if a person feels that they do not have a community to be viewed in? As an example, in the role of the military where many different people come to serve the country, can be viewed as a family structure. The military has several different subsystems, in which a person can be a part of. In my experience of this, I was a part of a battalion, which is a group of companies (people) that serves a main purpose in the military. There were several of these, and within these companies, they had their own rules besides the main rules that everyone had to follow.

Current Literature

Therapists are not immune to this destruction and may need to make changes in their practices and ultimately their theories to address global changes occurring in people (Rockinson-Szapkiw, et. al., 2011). Being abreast on the growing changes in the field of family counseling is imperative for counselors to maintain their effectiveness in the family systems. In this changing world, marriage and family therapists, while continuing to consider the family, will need to move beyond the individual, family, and community (emic) to a universal or global (etic) orientation in counseling and psychotherapy theory, research, and practice (Leong & Ponterotto, 2003).

In the current literature, only five family therapy models were used by more than 1% of all articles in some reviews (i.e., in addition to EFT, Bowen/transgenerational, cognitive marital therapy, contextual therapy, and structural therapy) (Chen, Hughes, & Austin, 2017). For emerging scholars, such as MFT graduate students, theory tends to be stressed least in training on scholarly research (Chen, et. al., 2017). It is prevalent in further research that is needed to continue evolving in the field. The findings suggest that over the last several years, family therapy researchers and scholars have considered the connection between theory and empirical research to a greater extent, thus indicating encouraging progress when it comes to theory and practice (Chen, et. al., 2017).

Family members may lose perspective, show the effects of immediate situations with past events, and become overwhelmed or cut off from painful feelings and contacts. (Walsh, 2003). Family counseling has become more necessary than ever with the growing issues of our youth. With things happening in the news with people getting shot by police, gang violence, and the drug epidemic in families, family counseling is needed now more than ever. Then in the community, the bigger picture is that it is hurting our foundation as a unit. Being cut off from situations that happened in the past not only hinders growth, but it serves as an opportunity for stepping above dated thought patterns.

Similarities to other Theories

Therapists such as Bowen, Satir, Haley, and Minuchin recognized that individuals were best understood in the context of their families and systems (Rockinson-Szapkiw, et. al., 2011). The following aspects of therapeutic relationships were distinguished: Bond, empathy, goal consensus, positive regard, congruence, collecting feedback from the patient, repairing relationship ruptures, avoiding countertransference, and matching the individual patient (Tschacher, Haken, & Kyselo, 2015). Learning about structural theory, the entire world is made up in systems, which is the groundwork for other theories.

With Minuchin’s revolutionary ideas and concepts such as boundaries, disengagement, and enmeshment, he profoundly influenced the fields of psychology, psychiatry, counseling, business, and education (Rockinson-Szapkiw, et. al., 2011). Structural, Strategic, and Cognitive Behavioral Family Therapy focuses on breaking or modifying the patterns of the family (Goldenberg et. al., 2017). In contrast, structural family therapy does not look at the unconscious situations of the family as psychodynamic theory does. Minuchin’s later influences included Adler’s work on the positive social, goal-oriented aspects of individuals; the concept of the family constellation; and the ability to make a change (Wycoff, & Cameron, 2000). This shows the growing work in structural family theory, and how the work in counseling always evolves in the field for the enrichment of the family system.

Part II. Personal Integration

I am a Christian. I have hope and faith that has gotten me through the tough times where my family system could not. Christian beliefs and values are crucial resources in times of family stress and providing hope in the midst of despair (Balswick, & Balswick, 2014). My faith has helped me through tough times of being a single parent to not knowing where my next meal would come from. I have gone through several different things in my life that has caused depression, anger, despair, and confusion when it comes to my family life. The effects of stressors may be positive and supportive or negative and destructive. (McLendon et. al., 2005). In my life, I have been through things that have shaken my faith but knowing that I believe in God has grounded me. Learning about this theory, doing my family genogram, and looking at the type of things my family goes through, gave me perspective on how my family is the way it is and what it would take to get healthier.

I moved away from home, standing on faith when I went to the military in 1999. I had to learn how to live without my family around. Although this was hard at times, I found it to be worthwhile. Locations in the social structure (e.g., participation in community organizations, involvement in social networks, and immersion in intimate relationships) enhance the likelihood of accessing support which in turn provides the protective function against distress (Lin, Ye, & Ensel, 1999). I had to change my family structure so that I can continue to be productive. Because of the move from Baton Rouge, LA, and getting out of the military, I had to change my thought processes when it came to my family that I left. I sought family in friends and in the neighborhood that I lived in. Learning how to be in the present so that I could survive without my family was hard, but I survived the hard times that laid ahead.

According to family systems theory, a healthy family is flexible enough to accommodate to developmental and cultural challenges, while supporting the growth of each individual member (Horigian, Anderson, & Szapocznik, 2016). I believe this to be true because in my life, my family has not been able to accommodate to the changes in my adult life. My adult life changes showed me that I can produce a change in my own family system. Changing the way that I think, do things, and show my family love is completely different from what I learned growing up. I have changed for the better and show a model of what I would like to see in my children.

My family was a hurting family. Hurting family tend to control rather than empower their members (Balswick, & Balswick, 2014). Learning that people can learn from the hurt and still prosper, was a pivotal point in my life. Putting God in the midst of your life will change everything. The breakthrough comes when one receives God’s unconditional love (Balswick, & Balswick, 2014). I have always known about God and his love, but only as a child. Learning this lesson when you are an adult is a totally different thing. Most families find strength, comfort, and guidance in adversity through connections with their cultural and religious traditions (Walsh, 2003). We are taught as Christians to honor our parents, and in the systems theory, we are taught to respect the patriarchal system as well. Although I learned to honor my parents, I didn’t feel loved at the time. I only learned that they did the best that they could when I became older.

Stepping away from my dysfunctional family system and on my faith in God exposed to me that I can truly do anything through Christ Jesus. The paradox of resilience is that the worst of times can also bring out our best (Walsh, 2003). Going through generational things has taught me that we can step out and dare to be different. It took a lot of mistakes making, and head bumping, but I have learned that when you pray about something, God always answers. It may not be the answer that you are looking for, but it is the answer that God has for you. In the scripture, it talks about God and answering prayers. The scripture says, “The LORD is near to all who call upon Him, to all who call upon Him in truth” (Psalm 145:18, ESV). I believe that God puts us all through things for a reason, and with that, I believe that I found my purpose.

I was taught to go to church, learn God’s way and follow his word. Growing up in the family system that I did, I was taught to “do as I say and not what I do”. This was very disruptive to me as a child. I still believe that I should follow God’s way, but it should be something that is practiced and not just preached by parents or elders. So where does this leave my family system? I believe that God has a purpose for us all, and that purpose for me is to be the groundbreaker of all of the dysfunction in my family system.

In the family systems theory in relation to my family, the boundaries are unclear. I have lived on my own since I was 19, but when my mother is around, it seems that she will not let go of the patriarchal role that she had when I was a younger child. Due to the power struggle in that aspect, we often have communication issues. My mother seems to have the old way of thinking that because she is the elder, what she says goes, but as an adult, I feel that my mother should not have a patriarchal role in my household. According to family systems theory, a healthy family is flexible enough to accommodate to developmental and cultural challenges, while supporting the growth of each individual member.

Conclusion

There is great concern across the mental health and social service fields that interventions capable of making a critical difference in the lives of individuals, couples, and families are not finding their way into regular practice (Withers, Reynolds, Reed, & Holtrop, 2017;2016;). This is why it is important for the world to normalize the counseling field. If it were normal for people to seek help, the world would be a better place. We as people should want to try new things to help the very people that need it. The family system is what needs help. Counseling from a systems theory can be educational as well as gratifying. Although some families are shattered by crisis or chronic stresses, what is remarkable is that many others emerge strengthened and more resourceful (Walsh, 2003). My family has been through a lot from generation to generation, but as the saying goes, once you learn better, you do better.

A family resilience perspective recognizes parental strengths and potential alongside limitations (Walsh, 2003). In the Turner family system, I have learned to apply what I have learned in life, counseling, and personal experiences so that I can help the family system become a better functioning unit. Although we do not live in the same area, there are ways to work on improving the relationships within the systems. With the advent and maturation of the Internet, more accessible air travel, continuing immigration and migration of world citizens, and increasing globalization of business, it is apparent that once-separate societies are becoming increasingly interconnected and interdependent (Leong & Ponterotto, 2003). We can talk on a weekly basis, make plans to visit one another and communicate how we feel more effectively. As a functioning unit, each part of that unit plays a role in the communication process and has to be a willing participant. The Turner family has to set boundaries with one another and be willing to respect each other in that aspect.

On the road ahead, I plan to be a willing participant to put these important concepts in place. As mentioned earlier, the Turner family has dysfunctional units in the system. To repair the unit, I will be a leading participant so that the family can see that it can be done. I plan to step out on God’s word and my faith so that the family system can be repaired. God will lead me, guide me and show me the way to make this family system better at communicating, building trust in the relationships, and seeing that repairing the system is worth it in order to lead future generations to be better than what we are now.

I desire to be a better version of myself. learning about myself will give me the understanding that I can’t make changes overnight. The Bible says, Therefore if anyone is in Christ, he is a new creation. The old has passed away; behold, the new has come (2 Corinthians 5:17). This shows me in written form that I can change, my family system can change, and the world overall can change. As long as God is at the forefront of my life, I can be an agent of change for the world and God can use me as a vessel as he sees fit.

References

1. Balswick, J. O., & Balswick, J. K. (2014). Family: a Christian Perspective on the Contemporary Home. Retrieved from https://ebookcentral-proquest-com.ezproxy.liberty.edu
2. Chen, R., Hughes, A. C., & Austin, J. P. (2017). The use of theory in family therapy research: Content analysis and update. Journal of Marital and Family Therapy, 43(3), 514-525.
3. Davis, K. M. (2001). Structural-strategic family counseling: A case study in elementary school counseling. Professional School Counseling, 4(3), 180-186.
4. Elbert, S., Rosman, B., Minuchin, S., & Guerney, B. (1964). a method for the clinical study of family interaction. The American Journal of Orthopsychiatry, 34(5), 885-894.
5. Goldenberg, I., Stanton, M., & Goldenberg, H. (2017). Family therapy: An overview. (9th ed.). Boston, MA: Cengage Learning.
6. [bookmark: _Hlk496132132]Horigian, V. E., Anderson, A. R., & Szapocznik, J. (2016). Taking brief strategic family therapy from bench to trench: Evidence generation across translational phases. Family Process, 55(3), 529-542.
7. Leong, F. T. L., & Ponterotto, J. (2003). Internationalizing counseling psychology: A proposal. The Counseling Psychologist, 31, 381-395
8. Lin, N., Ye, X., & Ensel, W. (1999). Social Support and Depressed Mood: A Structural Analysis. Journal of Health and Social Behavior, 40(4), 344-359.
9. Lindblad-Goldberg, M., & Northey Jr, W. F. (2013). Ecosystemic structural family therapy: Theoretical and clinical foundations. Contemporary Family Therapy, 35(1), 147-160.
10. McLendon, D., McLendon, T., & Petr, C. G. (2005). Family-Directed structural therapy. Journal of Marital and Family Therapy, 31(4), 327-339.
11. McNeil, S. N., Herschberger, J. K., & Nedela, M. N. (2013). Low-income families with potential adolescent gang involvement: A structural community family therapy integration model. The American Journal of Family Therapy, 41(2), 110-120.
12. Minuchin, P. (1985). Families and individual development: Provocations from the field of family therapy. Child Development, 56(2), 289–302.
13. Rockinson-Szapkiw, A. J., Payne, L. Z., & West, L. C. (2011). Leadership lessons from salvador minuchin. The Family Journal, 19(2), 191-197.
14. Sheehan, A. H., & Friedlander, M. L. (2015). Therapeutic Alliance and Retention in Brief Strategic Family Therapy: A Mixed-Methods Study. Journal of Marital and Family Therapy, 41(4), 415-427.
15. Walsh, F. (2003). Family resilience: A framework for clinical practice. Family Process, 42(1), 1-18.
16. Withers, M. C., Reynolds, J. E., Reed, K., & Holtrop, K. (2017;2016;). Dissemination and implementation research in marriage and family therapy: An introduction and call to the field. Journal of Marital and Family Therapy, 43(2), 183-197.
17. Wycoff, S., & Cameron, S. C. (2000). The Garcia Family: Using a structural systems approach with an alcohol-dependent family. The Family Journal, 8(1), 47-57.

Strategic theory and interventions strongly affect the founding of family therapy. Strategic family therapy focuses on affecting different family members through careful intervention planning and the publication of directives for resolving problems. These directives may appear to be in direct opposition to the goals of treatment. As we all know strategic therapy is one of the most widely studied approaches for treating family dysfunction.

Families undertake complex interactional orders that involve both verbal and nonverbal. For example, posture, intonation, volume, and different forms of communication. Family members continue to send and receive numerous messages. Strategic family approaches were designed to change psychological difficulties by solving problematic interactions between individuals. Especially, strategic family therapy helps one’s to state individual problems in the family. For instance, depression, anxiety, and Schizophrenia. Many psychological symptoms are stated as the results of misguided attempts at change. For example, concerned family members may attempt to protect one’s patient from anxiety by reorganizing activities and state out so that the patient is never left alone.

First, let’s talk about the history of strategic family therapy. The timeline affects strategic family therapy. The cybernetic theories of Gregory Bateson in 1940. Strategic family therapy developed from the strategic therapy of Milton Erickson in 1950s. The structural therapy of Minuchin in the 1960s. Also the brief therapy model of the Mental Research Institute and communication theory of Don Jackson. Moreover, Jay Haley & Cloe Madame combined these elements into strategic problem-solving therapy, which evolved into a family systems approach. Furthermore, the influence of cybernetics on strategic family therapy. There are 3 main models in this theory. First of all, the Mental Research Institute which started by Jackson who worked with Bateson, and with Haley on the Bateson project. The Haley and Madanes Strategic approach is influenced by Erikson, Bateson, and Minuchin. Erikson believed the unconscious was full of knowledge. Thus, no need to give people insight, just helps them to get access to it on one’s own. The MRI which is families makes basic knowledge however misguided one’s attempts to solve one’s problems. The solution selection as well as its success is affected by system rules. Identify the feedback loop, find the law governing and change the circulations and regulations. They are not interested in long-term change, insight, and what function the indication serves in the family, serious issue-focused behavioral change is important.

Haley and Madanes’ theories also take a fundamental role in the development of strategic family therapy. Four categories of problems result from their theories. Desire to control and dominate, desire to be loved, desire to love and protect others, and desire to repent and forgive. Therefore, Haley and Madanes are interested more in short sequences, but also in long ones that last years and reflect chronic structural problems. The Milan Group theories followed many of the works of MRI, Haley, and Madanes. Which worked with power struggles and boundaries, focused on long time spanning even multiple generations, and worked mostly with families which includes members with psychological problems, for example, depression or schizophrenic families.

Communication is an ever-present feature of human interaction. The five axioms of communication, formulated by Don Jackson help to describe the processes of communication that take place during interaction and help to explain how a misunderstanding may come about. This includes five main types of axioms. First of all, One cannot communicate. Secondly, Communication occurs on levels. Thirdly, Communication has content and relationship which is report and commands. Fourth, the relationship is defined by commands. Fifth, relationships are symmetrical or complementary.

First of all, one can not communicate ‘Activity or inactivity, words or silence all have message value, they influence others and these others, in turn, cannot respond to these communications and are thus themselves communicating’ (Watzlawick, Beavin, and Jackson, 1967) Everything does is a message, ‘Activity or inactivity, words or silence all have message value: they influence others and these others, in turn, cannot respond to these communications and are thus themselves communicating’ (Watzlawick, Beavin, and Jackson, 1967, p. 1). However, there is a problem, in the relationship system though. For instance, if one doesn’t want to communicate and inadvertently communicates this fact it may anger the other party. Insensitivity to these differences or the signals that people send may hinder or undermine a smooth process considerately.

Secondly, communication occurs on level ‘Content and relationship levels of communication’ The actual subject matter of what is being discussed is content. And the relationship level of a communicative is how the two communicators view one another and how they communicate it. As Watzlawick, Beavin, and Jackson (1967) said, ‘All relationship statements are about: ‘This is how I see myself, this is how I see you, this is how I see you seeing me’’ and further determines ‘how this communication is to be taken’. Watzlawick and Beavin (1967) state the relationship level of strategic family therapy is that ‘information about this information’ (p. 5).

Thirdly, Punctuation. How participants in the system punctuate their communicative sequences. In a communicative event ‘every item in the sequence is also stimulus, response and reinforcement’ (Bateson & Jackson qt. in Watzlawick, Beavin, and Jackson, 1967, p. 4). One can interpret an act as being a response. For example, ‘I don’t trust you, because you don’t share your feelings with me’. The other can interpret it as being a stimulus. For example, ‘I don’t share my feelings with people that don’t trust me’. Different punctuations make people see the sequence of events differently and may lead to incessant conflicts which make pointing the finger at each other which is pointless way.

Fourth, command and Report. Which is human communication pragmatics (Watzlawick, Beavin & Jackson, 1967), strongly influenced by Haley and Madame’s theory of one can not communicate. All research has a report and command function. ( Watzlawick, Bavelas, & Jackson, 1967) The report, or content of the message, conveys information. For instance, “our neighbor just insulted me!” may transmit a command. “Do something about it.” The command is not only captured by words, but also via nonverbal communication. In families, command messages are patterned as rules, which Jackson regulated family rules (Jackson, 1956) communication can be both digital and analogical. There are two different codes based on this theory. On one hand, digital code is what the person says, what the words actually mean. On the other hand, analogical code is how something is said or the nonverbal intimation that goes with it. This means that someone can convey two opposing messages at once, which may cause problems. It pays off to learn how to identify when people are silently saying yes, even when you hear ‘no’.

The fifth axiom was complementary and symmetrical communication. Concerned with the communication being complementary. Either the participants in the system are on the same ground with regard to power relations, or one of them is over the other.

Case conceptualization.

First of all, feedback loops which are the mechanisms of interactions through information are returned to the system and bring into influence it. There are both negative and positive feedback loops. The negative feedback loops are ways in which families correct dysfunction in family functioning so as to return it to a previous state. What are considered “Symptoms”? It’s the result of misguided attempts at changing an existing difficulty

(Watzlawick, 1974) Symptoms that make a family’s things worse. For instance, the depressed person whose family tries so hard to cheer him up, therefore, making him more and more depressed. This attempts to solve the problem and to deteriorate it. For conceptualization of “symptoms”, a symptom is refer to a communication act, with message qualities, which serves as a sort of contract between different members and has a function within the interpersonal network. (Haley, 1976) The family is an interpersonal system that is in many ways homologous to other cybernetics systems. (Hoffman, 1971).

The treatment goal has several goals. First-order change, occurs within a system according to the rules of the system and logical change to a problem. For a second-order change, a change in the rules of the system, and operating principles are changed and outside the change of effects with the whole system. And for manipulation is unavoidable all relationships have hidden agendas, which expected change in clients. Which focuses on creating second-order change, shift into a new level of homeostasis (Foley, 1986), Permanent after the temporary change (Foley, 1986), And the goal, changing the existing rules to create new problems (Reaser, 1982)

And following are therapeutic techniques that have several general characteristics, generally quite pragmatic, concerned with techniques that work only, care less about the family dynamic, symptom-focused, and behaviorally oriented. When power struggles are avoided, use indirect ways of turning the family’s involvement into positive use, positive interpretation, and homeostatic trends are employed. And cornerstones which are the utilization of tasks and directives. And there are problems that are solvable form, objectively agreed upon, and analyzed the outcome.

There are main techniques adopted. First of all, paradoxical communication. Paradoxical Communication, which does something that seems in opposition to the goals of treatment ( Stanton, M. D.1981). Secondly, assumption, which is great resistance to change, under considerable pressure to adopt its ways of interacting and communicating. And resist the therapist’s efforts to intake them change. Thirdly, directives, for instructions which homework assignments aimed to help families interrupt homeostatic patterns of problem-unsolvable behavior and families need to interact, negotiate and communicate with others about specific behavioral assignments. Fifth, help illuminate their processes of F.O & S.O change. For example, what they have tried in the past. Lastly, paradoxical directives, direct the client to continue, are non-confrontational, undermine resistance, and tie into patients.

The therapeutic double-bind which forces clients into a sure-win situation is Used to warn against precocious change, allowing the family to feel acceptable and unblamed, uncovers counter-paradoxical patterns, and interrupts unproductive games. And for prescription, there is serval symptom prescription. This included requests to continue to perform and expand the symptom, compliance-based and disdained-based. For positioning, enlarge or overstate the family’s explanation of the problem. And for restraining, and controlling techniques. This restraining technique includes attempts to discourage, or even deny the possibility of change, warned of the dangers of change, restrained from trying to change, asked to change slowly. For example “Go slowly,” “The situation appears hopeless,” or “Don’t change.” The family is conflicted about changing.

And strategy family therapy also includes rite, which alters dysfunctional familial dynamics which contribute to different family problems. For first and second-order change which engages families in a sequence of actions that contradicted family rules. Also made use to dramatize positive meaning. For example, power struggles in parenting. And reframing provides another meaning to explain an event (Piercy, et al.) and provides a new framework from which to evaluate interactions. This lead to changes in reactions to behaviors (first-order change) or to the alteration of rules that govern behavior (second-order change), do not necessarily have to reflect the actual truth, criticized for an overly pragmatic approach in which any reframe that might lead to a change was allowable and increased their efforts to be sensitive

For relabeling which positive connotation including similar to reframing, changing the label attached to a person or problem from negative to positive, what problem behaviors might actually serve a purpose in familial homeostasis, this particular pattern may not be needed to change and focus on larger issues instead. For instance, the Child “acts out” when parents arguing

For strengths, first of all, resolving presenting problems by focusing on behavioral sequences, getting people to behave differently, shifting the family organization so that the presenting problem is no longer functional, move the family toward the appropriate stage of family development, problems often arise during the transition from one developmental and stage to the next.

Secondly, the strategic approach solves through the presenting problem, individuals don’t develop problems in isolation, but as a response to their social environment, the therapist develops techniques for solving problems specific to the family’s interactions and structure and the therapist sees the problem as part of a sequence of interactions of those in the individual’s immediate social environment. Thirdly, symptoms of a particular pathology or behavior must be studied in relation to the family system. Fourth, the emphasis of the therapy is not on the individual but on the structure. Lastly, the goals of strategic family therapy are to solve problems, achieve the family’s goals ultimately, and change an individual’s dysfunctional or some problematic behaviors.

For weakness, first of all, giving one-sided reframings or paradoxical instructions. Secondly, the problems of conventional morality, deception regardless of motivation and circumstance is viewed as immoral (Kohlberg, 1969). Thirdly, deception is corrupt and not ethical to deceive a patient for the patient’s own good. There are also several risks in strategy family therapy. X long-term therapies involve a rapid destabilization of the current situation and change is initiated by the therapist with the use of interventions that are not substantially influenced by different factors.

For disrespectful, first of all, comparatively unconcerned with searching for and uncovering the “whys” of behavior (Haley, 1976). Secondly, differentiate the facts of functioning in human relationship systems (Bowen,1978) “how, when, and where they are taking place”. Thirdly, therapists are not obligated to explain the observations or share the basis for the interventions. Fourth, less concerned about the information flowing between therapists and insight-oriented therapists. Fifth, act on the information for discussion and share it completely, X takes patients entirely into confidence and suggested without a full revelation. Moreover, adaptation in Chinese definitely, Hong Kong is greatly influenced by Confucianism. However, how’s a strategic family related to Confucianism?

In conclusion, strategic family therapy conceptualize symptoms as the indicators of system stucking. In order to recover the system to a homeostatic state, people need to balance the imbalance system in a directive way. Although it can be used to change the system patterns it neglects affection and self-growth. That leads to its questionable application in the Chinese context.

Narrative family therapy

Proponents of narrative family therapy believe personal experience is ambiguous and reality is shaped by language–the reality is a subjective, socially constructed truth. Narrative therapy focuses on the effects of the client’s problem, not the cause, and dissects how the problem impacts the family at large. Narrative therapists view the client’s problem as the focal problem and view the client as secondary to the problem–the person is not the problem. (Gehart, 2014).

Core concepts.

• Dominant Narrative–a person’s beliefs, values, and practices based on dominant social culture
• Subjugated Narrative–a person’s own story that is suppressed by the dominant story
• Alternative Story–the story that is present but not noticed
• Deconstruction/re-authoring–taking apart the problem-saturated story in order to externalize and re-write the client’s story
• Problem-saturated Stories–the story that bogs the client down, allowing problems to persist
• The landscape of action–how people behave
• The landscape of consciousness–what meaning the problem has (landscape of meaning)
• Unique outcome/sparkling moments–pieces of the deconstructed story that would not have been predicted by the dominant story or problem-saturated story (Gehart, 2014).

Major interventions.

Narrative therapists help the client to separate the problem-saturated stories and destructive cultural assumptions to open space for new and more constructive views of themselves. Therapists challenge the client’s views by identifying unique outcomes or “sparkling events” when the family resisted the problem or behaved in ways that contradicted the problem story. Therapists ask questions to help clients with their story development, identify the problem, extend the story into the future, externalize or deconstruct the problem, and finally reauthor the client’s narrative (Gehart, 2014).

Goals and therapeutic outcomes.

The goals of Narrative therapy are to change the way the clients view themselves and assist them in re-authoring their story in a positive light–finding an alternative, but preferred story that is not problem-saturated. Therapy aims to give clients openings to different stories that don’t include problems by helping clients to separate the problem-saturated stories and destructive cultural assumptions. Reauthorizing helps foster a sense of personal agency among the family members by using an “audience” to acknowledge their success over the problem (Nichols et. al., 2017).

Evolution of Model.

Narrative therapy was created and influenced by the works of Michael White and David Epston who believed in the advantages of narratives and viewed stories as capturing lived time. White and Epston (1978), believed that stories are complex since they are inclusive rather than exclusive and can enrich events in people’s lives. White developed his approach around how problems affect people rather than the actions people take. By creating new narratives through reauthoring, clients become separated from instead of being defined by their problems.

David Epston, a family therapist, emphasized clients maintain their new reauthored narratives with the support of the community and developed self-help “leagues,” or groups of citizens battling similar problems to provide community and support. Epston also advocated for writing letters to clients upon completion of therapy (Nichols et. al., 2017).

Critique of cultural sensitivity.

Overt and covert values.

Narrative therapy values a general approach to working with individuals and families that uses metaphors and languages associated with the narrative process in order to help clients understand the problems in their lives, separate from them, and create alternative life stories. The oral tradition of transmitting information through storytelling can be found in cultures around the world which enables Narrative therapy to be open to cross-cultural communications.

Based on social constructivism philosophy, narrative models share a belief in the power of language to oppress or liberate people. Every individual has the ability to “reauthor” their life through the process of therapeutic conversations. The narrative theory rejects the notion of universal truth in favor of multiple realities and perspectives. Thus, the client is regarded as the expert on their story (White & Epston 1990).

Experiential Family Therapy

Assumptions of problems and solutions.

Experiential therapists believe family difficulties and problems are caused by emotional suppression. Parents who regulate and control children’s feelings result in children who suppress or blunt their emotional experiences: dysfunctional families are less tolerant of emotions.

Experiential therapy aims to change families by helping them to openly express their emotions, hopes, desires, fears, and anxieties. Since emotions organize attachment responses and serve a main communicative function in relationships, denial of impulses and suppression of feelings are the root of family problems (Greenberg & Johnson, 2010).

Experiential therapists believe that the family is locked into a pattern of self-protection and avoidance and seeks security rather than satisfaction by smothering emotion and desire. When a family is fearful of conflict, they adhere rigidly to the rituals they established and cling to routines–resulting in an unhealthy family that stays together out of habit or duty (Satir, 1972).

Core concepts.

• Alienation
• Battle for Structure
• Battle for Initiative
• Blaming
• Being irrelevant/irreverent
• Being super reasonable/Placating
• Communication
• Creativity
• Experiential
• Family Reconstruction
• Growth thru immediate shared experience
• Honest emotion
• Suppression/repression
• Family myths
• Mystification
• Intergenerational themes
• Self Worth

Major interventions.

Experiential techniques are aimed at promoting communication and interaction to open individuals to new experiences in order to change the family dynamic. Creating personal therapeutic encounters through structured exercises and techniques, therapists aim to liberate impulses for individual growth and family cohesion (Whitaker, 1973):

• Family sculpting: one member of the family arranges others in a scene
• Conjoint family drawing: members draw a picture as they see themselves in the family
• Family puppet interviews: the family makes up a story using puppets
• Role-playing: past events and events hoped for and/or feared are made more immediate
• Gestalt empty chair: an individual talks to an empty chair to personify the subject and promote effective expression
• Psychology of the absurd: taking clients’ statements to the extreme

Goals and therapeutic outcomes.

The goals of Experiential family therapy are to promote individual and family growth through shared experience and emotional expression. Therapy aims to improve family relationships by increasing personal integrity and enhancing growth and self-awareness–enabling family members to be more authentic. This can allow the family to establish a sense of belonging within the family unit. Additionally, learning to interpret anger as hurt or by explaining the purpose of pain reduces individual and family defenses. Educating clients about their roles in the family can increase self-control and accountability (Nichols, et. al. 2017).

Evolution of Model.

Experiential family therapy, which grew out of existential and humanistic psychology, peaked in the 1970s and is one of the seminal first-generation family therapy models. Experiential therapy focuses on the needs of the family and has roots in psychodrama, Gestalt therapy, and encounter groups. Experiential family therapy was created by Carl Whitaker and Virginia Satir.

Carl Whitaker focused on an intuitive approach to therapy and was among the first to conduct therapy with families. Whitaker believed in “Therapy of the absurd,” highlighting unconventional and playful wisdom to connect individuals and families (Nichols, et. al., 2017). Virginia Satir, one of the first prominent women in the field, began her career in family therapy at the Mental Research Institute (MRI). Satir focused on fostering individual growth as well as improving family interactions using experiential exercises, metaphors, coaching, and the self of the therapist to facilitate change. Satir focused on being highly nurturing, empathetic, and genuine using techniques of touch and sculpting and stressed the importance of quality communication among family members.

Critique of cultural sensitivity.

Overt and covert values.

Experiential therapists believe family difficulties and problems are caused by emotional suppression by parents who regulate and control children’s feelings and view dysfunctional families as less tolerant of emotions. Children who grow up in an atmosphere of support when expressing their feelings and creative impulses are encouraged to experience life and the full range of human emotions fully. A healthy family offers its members the freedom to be themselves (Gehart, 2014).

Power and Social Justice

Narrative Family Therapy

Social context.

According to Foucault, the power of the dominant narrative, or status quo, in a society pervades all aspects of life and subjugates through language. In order for clients and therapists to establish an alliance, the therapist’s ideas, values, prejudices, etc. need to be open to the client, and transparency needs to be established. Narrative therapists need to be expert conversationalists, to engage the family and enable the family to share and then reauthor their own stories. Narrative family therapy is rooted in postmodernism and social constructivist thought and dismisses modernist views as expert knowledge, objective reality, and the need for therapist detachment (Gehart, D. 2014).

Strengths and weaknesses.

Narrative intelligibility or the idea that stories don’t just mirror life they shape it is at the core of Narrative therapy. Therapists focus on how much narrative accounts affected people’s perceptions. Narrative therapists believe that problems arise when people are indoctrinated into narrow and self-defeating views of themselves. Clients can develop alternative empowering stories if they can distance themselves from their problems and the cultural myths they have internalized. Narrative therapy relies heavily on the motivation and language of the client to uncover their problems and identify solutions that allow little room for miscommunication or a lack of follow-through (White, Michael 2007).

Experiential Family Therapy

Social context.

Experiential therapy can focus on emotional processes and family structure by relying on emotional and not cognitive logic. The use of symbolism and real-life experiences as well as humor, play, and affective confrontation are utilized to promote emotional processing. Experiential therapy was developed in response to perceived limitations in psychoanalysis and behaviorism and emphasizes freedom and the immediacy of experience. This form of therapy values the individual experience over the family structure (Satir, V. 1972).

Strengths and weaknesses.

Experiential therapy focuses on four types of destructive communication that are used as communication coping strategies: Blaming, Placating, Being irrelevant and Being super reasonable. These four types of destructive communication develop during childhood and reveal how a person communicates under stress. By identifying a client’s communication style, the therapist can focus on the perception of the problem between couples. Since experiential therapy focuses on interpretations, leaving room for discussions to be taken out of context. Since success depends on the collaboration of several people, this can lead to high dropout rates (Johnson & Denton, 2002).

Clinical Application

Narrative Family Therapy

Modifications to the concept of deconstruction and re-authoring

Re-authoring conversations take place between a therapist and the client and involve the identification and co-creation of alternative storylines of identity. The practice of re-authoring is based on the assumption that no one story can summarize a client; there will always be other storylines that can be created from the events of our lives. As such, our identities are not single-storied–we are multi-storied. According to White (2001), narrative practices explore the intentions, hopes, values, and commitments that shape people’s actions rather than any internal deficiencies. Inviting creativity and flexibility into the therapy room can enable clients to be open to or create more diverse dominant narratives which are more culturally relevant (Gehart, D. 2014).

Experiential Family Therapy

Modification to the concept of a battle for structure

According to Napier & Whitaker (1978), families come into therapy with their own structure, tone, and rules. The family organization and patterns have been established over years of living and are extremely meaningful and painful. The family counts on the familiarity and predictability of their world. If the family is going to expose this painful predictability and attempt to reorganize themselves, they will need firm external support.

Since individuals interpret behaviors and emotions in a variety of ways, Napier and Whitaker (1978) focus on concepts of the battle for structure and the battle for the initiative. Using collaboration, empathy, and gentle language which maintains appropriate boundaries, one can guide clients securely through treatment, as they find their culturally specific resources and relational courage.

Conclusion

Both Experiential and Narrative family therapies focus on the client’s perception of themselves and view outside factors as the problem, not something that is inherently wrong with the client. Viewing reauthoring and the battle for structure through a power and social justice lens enables families–and communities and society–to be more culturally sensitive. When individuals feel empowered to define and own their own stories/themselves, they have no reason to fear ‘the other’ in any context. Clients can reauthor or fully experience their emotions behind their socially constructed view of identity to change their worldviews from within.

The McCoy Family Identifying Information

The McCoy family consists of Ed McCoy aged thirty-six and his 3 school-aged children. The names and ages of the children are Tamara-10, Kayla-8, and Kyle-4. Ed was married to the mother of the children, Tina until her untimely death caused by a connective tissue disorder three months ago.

Family Structure and Development

The McCoy family structure is that consisting of mostly extended family members. Prior to the death of Tina, the McCoy family would be considered a joint family as it consisted of children, parents, and grandparents both maternal and paternal. Tina was close to her immediate family however; Ed and his immediate family are not close. The lack of closeness involves distance and emotion. After the death of Tina, the relationship between Ed and his in-law is strained.

Initial Presentation

Ed is a thirty-six-year-old widow with a slender build. Their initial appearance of Ed is that of being unkempt. Ed is linear in thought, however, flat in effect and is easily distracted. Tamara, aged ten is the oldest of the McCoy children. Tamara has long brown hair, is well-behaved, and is quiet. Kayla age eight is the second oldest of the McCoy children. Kayla is tall and slender with short dark hair. During the initial interview, Kayla maintained pleasant facial expressions. Kyle, the youngest at age four and the only boy in the McCoy family appears to be happy and content with his family situation.

Family Functioning

Since the death of his wife, Ed has all but allowed Tamara to fill in as the surrogate mother to the children in the home. This was evident by Ed mentioning how Tamara was a “good little mother”. The children appear to have met age benchmarks. Ed reports being emotionally distant from his children placing added responsibility and burden on Tamara. The distance shown by Ed could be the cause for the defiance shown by Kayla and why Kyle looks to his sibling sisters for his emotional support.

Intervention History

There has been no history of intervention involving the McCoy family.

Current Family Strengths, Problems, and Conflicts

The McCoy family benefits from a large and strong support system. The support system ranges from educators in the children’s schools, friends, and Tina’s mother and sister. Unfortunately, the dynamics in the family prior to Tina’s death did not allow for putting the supports in place. As a strength, Ed is an excellent provider to his children. Ed’s wanting to provide for his family is also a problem as it means that he cannot always be available to his children, leaving them to be nurtured by other people. Ed and Tina did not share roles and as a result, Ed is left with a responsibility that he was not prepared to take on. Ed’s relationship with his family also proves to be problematic as the lack of being connected with his mother and sister eliminates another possible resource that he and his children could benefit from having. Conflict is consistent in the McCoy and extended family members. There was a conflict in the marriage prior to Tina’s death over shared parenting responsibilities and a two-income home. Ed is conflicted because he desires to be a parent that is present in the lives of his children although his upbringing provided little to no example of how a father is involved in the lives of his children. There is a conflict between Ed, his mother-in-law, and his sister-in-law as they offer to assist with raising the children, but they do so in an aggressive manner putting Ed in a defensive state.

Assessment Tools

A family process assessment would be beneficial in this instance. The family process discusses the behaviors and interactions that show family functioning. Areas discussed are various ways of managing conflict and methods to solve problems. The concepts of distinction, individuation, verbal messaging, and influence among family members are explained by the family process assessment.

Summary of Family Structure and Functioning

The McCoy family is one that is saddled with grief, confusion, and inability to communicate. Ed lost his wife and is now charged with raising three children. Unfortunately for Ed, his upbringing nor his relationship with his deceased wife provided him with the ability to do so. Ed’s inability to recognize those wanting to support him during this unfortunate time of transition may create an irreparable wedge between his children and himself as they seek emotional support from elsewhere as they feel abandoned by their father.

Treatment/Intervention

What can be seen from this case is that communication proves to be the biggest barrier. Ed is ill-equipped to care for three young children alone. Unfortunately for Ed, he has never been in a situation where he was expected or taught to expect that he would be responsible for the nurturing aspect of parenthood. As a default, Ed continues with his traditional role; he continues to be a provider. Ed, his mother-in-law Grace, and his sister-in-law Rhonda are all grieving, but lack either the willingness or ability to discuss the pain associated with losing their loved one Tina.

A beneficial treatment would be that family-focused grief therapy. Family-focused grief therapy dives into a family’s feelings about the loss and ways of coping with a relative’s death. The goal is to encourage mutual grief resulting in the best possible family functioning. Family-focused grief therapy offers benefits as it enhances functioning in the family by exploring its cohesion, feelings surrounding the loss, and handling of conflict (Kissane, et al., 2006). The hope for this therapy is that all members will come to terms with not only the loss of Tina but also understand that the emotional health of themselves and the children requires everyone to work as a team.

Ed and the children would also benefit child parent relationship therapy. A major strain has been identified between Ed and his children. A concern mentioned by Ed is his lack of attachment to his children. Studies show that the bond created between an infant and the primary caregiver has a significant effect on the development of a child (Sergeant, 2011). Since birth, Tina was the primary caregiver to the children. Now that she is deceased this responsibility falls to Ed. Bringing Ed and the children into a therapeutic setting will allow this bond to be created. Ed will be shown the importance of his role as it relates to parenting and the children will foster the feeling of closeness with their remaining parent.

References

1. Kissane, D. W., McKenzie, M., Bloch, S., Moskowitz, C., McKenzie, D. P., & O’Neill, a. I. (2006). Family Focused Grief Therapy: A Randomized, Controlled Trial in Palliative Care and Bereavement. American Journal of Psychiatry, 1208-1218.
2. Sergeant, M. (2011). Efficacy of child-parent relationship therapy for caregivers of children with attachment problems. Louisville: The University of Louisville’s Institutional Repository.

The McCoy Family Identifying Information

The McCoy family consists of Ed McCoy aged thirty-six and his 3 school-aged children. The names and ages of the children are Tamara-10, Kayla-8, and Kyle-4. Ed was married to the mother of the children, Tina until her untimely death caused by a connective tissue disorder three months ago.

Family Structure and Development

The McCoy family structure is that consisting of mostly extended family members. Prior to the death of Tina, the McCoy family would be considered a joint family as it consisted of children, parents, and grandparents both maternal and paternal. Tina was close to her immediate family however; Ed and his immediate family are not close. The lack of closeness involves distance and emotion. After the death of Tina, the relationship between Ed and his in-law is strained.

Initial Presentation

Ed is a thirty-six-year-old widow with a slender build. Their initial appearance of Ed is that of being unkempt. Ed is linear in thought, however, flat in effect and is easily distracted. Tamara, aged ten is the oldest of the McCoy children. Tamara has long brown hair, is well-behaved, and is quiet. Kayla age eight is the second oldest of the McCoy children. Kayla is tall and slender with short dark hair. During the initial interview, Kayla maintained pleasant facial expressions. Kyle, the youngest at age four and the only boy in the McCoy family appears to be happy and content with his family situation.

Family Functioning

Since the death of his wife, Ed has all but allowed Tamara to fill in as the surrogate mother to the children in the home. This was evident by Ed mentioning how Tamara was a “good little mother”. The children appear to have met age benchmarks. Ed reports being emotionally distant from his children placing added responsibility and burden on Tamara. The distance shown by Ed could be the cause for the defiance shown by Kayla and why Kyle looks to his sibling sisters for his emotional support.

Intervention History

There has been no history of intervention involving the McCoy family.

Current Family Strengths, Problems, and Conflicts

The McCoy family benefits from a large and strong support system. The support system ranges from educators in the children’s schools, friends, and Tina’s mother and sister. Unfortunately, the dynamics in the family prior to Tina’s death did not allow for putting the supports in place. As a strength, Ed is an excellent provider to his children. Ed’s wanting to provide for his family is also a problem as it means that he cannot always be available to his children, leaving them to be nurtured by other people. Ed and Tina did not share roles and as a result, Ed is left with a responsibility that he was not prepared to take on. Ed’s relationship with his family also proves to be problematic as the lack of being connected with his mother and sister eliminates another possible resource that he and his children could benefit from having. Conflict is consistent in the McCoy and extended family members. There was a conflict in the marriage prior to Tina’s death over shared parenting responsibilities and a two-income home. Ed is conflicted because he desires to be a parent that is present in the lives of his children although his upbringing provided little to no example of how a father is involved in the lives of his children. There is a conflict between Ed, his mother-in-law, and his sister-in-law as they offer to assist with raising the children, but they do so in an aggressive manner putting Ed in a defensive state.

Assessment Tools

A family process assessment would be beneficial in this instance. The family process discusses the behaviors and interactions that show family functioning. Areas discussed are various ways of managing conflict and methods to solve problems. The concepts of distinction, individuation, verbal messaging, and influence among family members are explained by the family process assessment.

Summary of Family Structure and Functioning

The McCoy family is one that is saddled with grief, confusion, and inability to communicate. Ed lost his wife and is now charged with raising three children. Unfortunately for Ed, his upbringing nor his relationship with his deceased wife provided him with the ability to do so. Ed’s inability to recognize those wanting to support him during this unfortunate time of transition may create an irreparable wedge between his children and himself as they seek emotional support from elsewhere as they feel abandoned by their father.

Treatment/Intervention

What can be seen from this case is that communication proves to be the biggest barrier. Ed is ill-equipped to care for three young children alone. Unfortunately for Ed, he has never been in a situation where he was expected or taught to expect that he would be responsible for the nurturing aspect of parenthood. As a default, Ed continues with his traditional role; he continues to be a provider. Ed, his mother-in-law Grace, and his sister-in-law Rhonda are all grieving, but lack either the willingness or ability to discuss the pain associated with losing their loved one Tina.

A beneficial treatment would be that family-focused grief therapy. Family-focused grief therapy dives into a family’s feelings about the loss and ways of coping with a relative’s death. The goal is to encourage mutual grief resulting in the best possible family functioning. Family-focused grief therapy offers benefits as it enhances functioning in the family by exploring its cohesion, feelings surrounding the loss, and handling of conflict (Kissane, et al., 2006). The hope for this therapy is that all members will come to terms with not only the loss of Tina but also understand that the emotional health of themselves and the children requires everyone to work as a team.

Ed and the children would also benefit child parent relationship therapy. A major strain has been identified between Ed and his children. A concern mentioned by Ed is his lack of attachment to his children. Studies show that the bond created between an infant and the primary caregiver has a significant effect on the development of a child (Sergeant, 2011). Since birth, Tina was the primary caregiver to the children. Now that she is deceased this responsibility falls to Ed. Bringing Ed and the children into a therapeutic setting will allow this bond to be created. Ed will be shown the importance of his role as it relates to parenting and the children will foster the feeling of closeness with their remaining parent.

References

1. Kissane, D. W., McKenzie, M., Bloch, S., Moskowitz, C., McKenzie, D. P., & O’Neill, a. I. (2006). Family Focused Grief Therapy: A Randomized, Controlled Trial in Palliative Care and Bereavement. American Journal of Psychiatry, 1208-1218.
2. Sergeant, M. (2011). Efficacy of child-parent relationship therapy for caregivers of children with attachment problems. Louisville: The University of Louisville’s Institutional Repository.