Marriage and Family Therapy: Theory and Techniques
Family systems theory emerged from Ludwig Von Bertalanffy's work on general systems theory which offered the world of the mid-twentieth century a different way of viewing science. Instead of the mechanistic models of the time, von Bertalanffy's general systems theory argued that organisms are complex, organized, and interactive. Such an approach shifted from a linear causal model to models that required a broader, holistic orientation in order to understand fully the dynamics involved. Von Bertalanffy's work on general systems theory found wide applicability in such fields as community planning, computer science and programming, and the social sciences. By the close of the twentieth century family systems theory had become one of the major theoretical foundations guiding empirical investigations into the study of families and from which clinical interventions and programmatic work with families were being developed.
A general systems perspective examines the way components of a system interact with one another to form a whole. Rather than just focusing on each of the separate parts, a systems perspective focuses on the connectedness and the interrelation and interdependence of all the parts. A systems perspective permits one to see how a change in one component of the system affects the other components of the system, which in turns affects the initial component. The application of the systems perspective has particular relevance to the study of the family as families are comprised of individual members who share a history, have some degree of emotional bonding, and develop strategies for meeting the needs of individual members and the family as a group. Family systems theory allows one to understand the organizational complexity of families, as well as the interactive patterns that guide family interactions.
Family systems therapy is a branch of psychotherapy that works with families and couples in intimate relationships to nurture change and development. It tends to view these in terms of the systems of interaction between family members. It emphasizes family relationships as an important factor in psychological health. As such, family problems have been seen to arise as an emergent property of systemic interactions, rather than to be blamed on individual members. Marriage and Family Therapists (MFTs) are the most specifically trained in this type of psychotherapy.
Family therapists may focus more on how patterns of interaction maintain the problem rather than trying to identify the cause, as this can be experienced as blaming by some families. It assumes that the family as a whole is larger than the sum of its parts. Family therapy may also be used to draw upon the strengths of a social network to help address a problem that may be completely externally caused rather than created or maintained by the family.
Scientific research clearly indicated that Family therapy has been used effectively where families, and or individuals in those families experience or suffer serious psychological disorders (e.g. schizophrenia, anxiety, depression, personality disorders, conduct disorders, ADHD, addictions and eating disorders); interactional and transitional crises in a family’s life cycle (e.g. conflict, estrangement, divorce, child and adolescent issues); as a support of other psychotherapies and medication. Unfortunately, the vast majority of therapists, including in the Lehigh Valley, continue to use individual models for treating many disorders--such as Oppositional Defiant Disorder, Attention Deficit Hyperactivity Disorder, Eating Disorders, etc.--even though scientific research clearly demonstrates that these individual treatment models are non-effective.
The basic theory of classical systemic family therapy was derived mainly from systems theory and cybernetics, and secondarily from behavioral therapy and cognitive psychotherapy, although most of the founders of the field had psychoanalytic backgrounds. More recent developments have come from feminist, postmodernist, narrative, psychodynamic and attachment theories.
Important schools of family therapy include structural family therapy, strategic family therapy, a range of cognitive and behavioral approaches, constructivist (eg, Milan systems, post-systems/collaborative/conversational, reflective), solution-focused therapy, psychodynamic, object relations, intergenerational (Bowen systems theory, Contextual therapy), EFT (emotionally focused therapy), and experiential therapy. Multicultural, intercultural, and integrative approaches are being developed. Most practitioners claim to be "eclectic", using techniques from several areas, depending upon their own inclinations and/or the needs of the client(s).
This is also true at Covenant Counseling Services, as it would be as just about any other practice which specializes in Marriage and Family Therapy However, Covenant Counseling Services particularly emphases both the Bowenian and Structural models of Marriage and Family Therapy.
Characteristics of a Healthy Family
• Communication - clear, open, direct (verbal & non-verbal), feelings and emotions freely expressed, anger seen as a need for change, each hears and responds to others
• Autonomy - family consists of separate individuals, each takes responsibilty for personal actions and behaviour
• Acceptance - respect for the unique experience of others
• Structure - clear, flexible roles, the family script, consistent rules help resolve conflict
• Leadership - power shared appropriately by parents, fair without domination, humiliation or scapegoating, no one told what to think or feel, even the youngest is considered able to contribute
• Partnership - strong bonding and coalition of parents
• Flexibility - give and take, adapt to individual needs & changing circumstances, change not seen as threatening
• Support networks - inside and outside the family, provide strength & stability for coping with problems & stresses
• Family time - attention is paid to doing things together
• Growth - warm, nurturing, fulfilling atmosphere
• Need for intimacy - tenderness not seen as weakness, sexual interest considered a generally positive force
• Religion, philosophy and reality - positive values and beliefs, world-view is realistic but extends beyond the present
Reference:
No Single Thread: Psychological Health in Family Systems, JM Lewis et al, 1976, Brunner/Mazel, New York (Study by the Timberlawn Foundation, Dallas, Texas)
Global Assessment of Relational Functioning (GARF) Scale*
Instructions: The GARF scale can be used to indicate an overall judgement of the functioning of a family or other ongoing relationship on a hypothetical continuum ranging from competent, optimal relational functioning to a disrupted, dysfunctional relationship. The GARF scale permits the clinician to rate the degree to which a family or other ongoing relational unit meets the affective or instrumental needs of its members in the following areas:
A. Problem solving – skills in negotiating goals, rules and routines; adaptability to stress; communication skills; ability to resolve conflict.
B. Organisation – maintenance of interpersonal roles and subsystem boundaries; hierarchical functioning; coalitions and distribution of power, control and responsibility.
C. Emotional climate – tone and range of feelings; quality of caring, empathy, involvement, and attachment/commitment; sharing of values; mutual affective responsiveness, respect and regard; quality of sexual functioning
Note: Use specific, intermediate codes when possible, for example 45, 68,72. If detailed information is not adequate to make specific ratings, use midpoints of the five ranges, that is 90, 70, 50, 30 or 10.
81-100 Overall: Relational unit is functioning satisfactorily from self-report of participants and from perspectives of observers.
• Agreed on patterns or routines exist that help meet the usual needs of each family/couple member; there is flexibility for change in response to unusual demands or events; and occasional conflicts and stressful transitions are resolved through problem-solving communication and negotiation.
• There is a shared undertaking and agreement about roles and appropriate tasks, decision making is established for each functional area, and subsystem (eg parents-spouses, siblings and individuals).
• There is a situationally appropriate, optimistic atmosphere in the family; a wide range of feelings is freely expressed and managed within the family; and there is a general atmosphere of warmth, caring and sharing of values among all family members. Sexual relations of adult members are satisfactory.
61-80 Overall: Functioning of relational unit is somewhat unsatisfactory. Over a period of time, many but not all difficulties are resolved without complaints.
• Daily routines are present but there is some pain and difficulty in responding to the unusual. Some conflicts remain unresolved but do not disrupt family functioning.
• Decision making is usually competent, but efforts at control of one another are often greater than necessary or are ineffective. Individuals and relationships are clearly demarcated but sometimes a specific subsystem is depreciated or scapegoated.
• A range of feeling is expressed, but instances of emotional blocking or tension are evident. Warmth and caring are present but are marred by a family member’s irritability and frustrations. Sexual activity of adult members may be reduced or problematic.
41-60 Overall: Relational unit has occasional times of satisfying and competent functioning together, but clearly dysfunctional, unsatisfying relationships tend to predominate.
• Communication is frequently inhibited by unresolved conflicts that often interfere with daily routines; there is significant difficulty in adapting to family stress and transitional change.
• Decision making is only intermittently competent and effective; either excessive rigidity or significant lack of structure is evident at these times. Individual needs are quite often submerged by a partner or coalition.
• Pain or ineffective anger or emotional deadness interfere with family enjoyment. Although there is some warmth and support for members, it is usually unequally distributed. Troublesome sexual difficulties between adults are often present.
21-40 Overall: Relational unit is obviously and seriously dysfunctional; forms and time periods of satisfactory relating are rare.
• Family/couple routines do not meet the needs of members; they are grimly adhered to or blithely ignored. Life cycle changes, such as departures or entries into the relational unit generate painful conflict and obviously frustrating failures of problem solving.
• Decision making is tyrannical or quite ineffective. The unique characteristics of individuals are unappreciated or ignored by either rigid or confusingly fluid coalitions.
• There are infrequent periods of enjoyment of life together; frequent distancing or open hostility reflect significant conflicts that remain unresolved and quite painful. Sexual dysfunction among adult members is commonplace.
1-20 Overall: Relational unit has become too dysfunctional to retain continuity of contact and attachment.
• Family/couple routines are negligible (eg no mealtime, sleeping or waking schedule); family members often do not know where others are or when they will be in or out; there is a little effective communication among family members.
• Family/couple members are not organised in such a way that personal or generational responsibilities are recognised. Boundaries of relational unit as a whole and subsystems cannot be identified or agreed on. Family members are physically endangered or injured or seriously attacked.
• Despair and cynicism are pervasive; there is little attention to the emotional needs of others: there is almost no sense of attachment, commitment or concern about one anothers welfare.
0: Inadequate information.
Basic Techniques in Marriage and Family Counseling and Therapy.
MFTs work effectively with individuals, couples and families experiencing a wide variety of issues and problems. Structural, strategic, and transgenerational family therapists at times may seem to be operating alike, using similar interventions with a family. Differences might become clear when the therapist explains a certain technique or intervention. Most of today's practicing MFTs go far beyond the limited number of techniques usually associated with a single theory.
TECHNIQUES
The following select techniques have been used in working with couples and families to stimulate change or gain greater information about the family system. Each technique should be judiciously applied and viewed as not a cure, but rather a method to help mobilize the family. The when, where, and how of each intervention always rests with the MFT's professional judgment and personal skills.
THE GENOGRAM
The genogram, a technique often used early in family therapy, provides a graphic picture of the family history. The genogram reveals the family's basic structure and demographics. (McGoldrick & Gerson, 1985). Through symbols, it offers a picture of three generations. Names, dates of marriage, divorce, death, and other relevant facts are included in the genogram. It provides an enormous amount of data and insight for the therapist and family members early in therapy. As an informational and diagnostic tool, the genogram is developed by the MFT in conjunction with the family.
THE FAMILY FLOOR PLAN
The family floor plan technique has several variations. Parents might be asked to draw the family floor plan for the family of origin. Information across generations is therefore gathered in a nonthreatening manner. Points of discussion bring out meaningful issues related to one's past.
Another adaptation of this technique is to have members draw the floor plan for their nuclear family. The importance of space and territory is often inferred as a result of the family floor plan. Levels of comfort between family members, space accommodations, and rules are often revealed. Indications of differentiation, operating family triangles, and subsystems often become evident. Used early in therapy, this technique can serve as an excellent diagnostic tool.
REFRAMING
Most MFTs use reframing as a method to both join with the family and offer a different perspective on presenting problems. Specifically, reframing involves taking something out of its logical class and placing it in another category (Sherman & Fredman, 1986). For example, a mother's repeated questioning of her daughter's behavior after a date can be seen as genuine caring and concern rather than that of a nontrusting parent. Through reframing, a negative often can be reframed into a positive.
TRACKING
Most family MFTs use tracking. Structural family therapists (Minuchin & Fishman, 1981) see tracking as an essential part of the therapist's joining process with the family. During the tracking process the therapist listens intently to family stories and carefully records events and their sequence. Through tracking, the family therapist is able to identify the sequence of events operating in a system to keep it the way it is. What happens between point A and point B or C to create D can be helpful when designing interventions.
COMMUNICATION SKILL-BUILDING TECHNIQUES
Communication patterns and processes are often major factors in preventing healthy family functioning. Faulty communication methods and systems are readily observed within one or two family sessions. A variety of techniques can be implemented to focus directly on communication skill building between a couple or between family members. Listening techniques including restatement of content, reflection of feelings, taking turns expressing feelings, and nonjudgmental brainstorming are some of the methods utilized in communication skill building.
In some instances the MFT may attempt to teach a couple how to fight fair, to listen, or may instruct other family members how to express themselves with adults. The family therapist constantly looks for faulty communication patterns that can disrupt the system.
FAMILY SCULPTING
Developed by Duhl, Kantor, and Duhl (1973), family sculpting provides for recreation of the family system, representing family members relationships to one another at a specific period of time. The MFT can use sculpting at any time in therapy by asking family members to physically arrange the family. Adolescents often make good family sculptors as they are provided with a chance to nonverbally communicate thoughts and feelings about the family. Family sculpting is a sound diagnostic tool and provides the opportunity for future therapeutic interventions.
FAMILY PHOTOS
The family photos technique has the potential to provide a wealth of information about past and present functioning. One use of family photos is to go through the family album together. Verbal and nonverbal responses to pictures and events are often quite revealing. Adaptations of this method include asking members to bring in significant family photos and discuss reasons for bringing them, and locating pictures that represent past generations. Through discussion of photos, the MFT often more clearly sees family relationships, rituals, structure, roles, and communication patterns.
SPECIAL DAYS, MINI-VACATIONS, SPECIAL OUTINGS
Couples and families that are stuck frequently exhibit predictable behavior cycles. Boredom is present, and family members take little time with each other. In such cases, family members feel unappreciated and taken for granted. "Caring Days" can be set aside when couples are asked to show caring for each other. Specific times for caring can be arranged with certain actions in mind (Stuart, 1980).
THE EMPTY CHAIR
The empty chair technique, most often utilized by Gestalt therapists (Perls, Hefferline, & Goodman, 1985), has been adapted by MFTs. In one scenario, a partner may express his or her feelings to a spouse (empty chair), then play the role of the spouse and carry on a dialogue. Expressions to absent family, parents, and children can be arranged through utilizing this technique.
FAMILY CHOREOGRAPHY
In family choreography, arrangements go beyond initial sculpting; family members are asked to position themselves as to how they see the family and then to show how they would like the family situation to be. Family members may be asked to reenact a family scene and possibly resculpt it to a preferred scenario. This technique can help a stuck family and create a lively situation.
FAMILY COUNCIL MEETINGS
Family council meetings are organized to provide specific times for the family to meet and share with one another. The MFT might prescribe council meetings as homework, in which case a time is set and rules are outlined. The council should encompass the entire family, and any absent members would have to abide by decisions. The agenda may include any concerns of the family. Attacking others during this time is not acceptable. Family council meetings help provide structure for the family, encourage full family participation, and facilitate communication.
STRATEGIC ALLIANCES
This technique, often used by strategic family therapists, involves meeting with one member of the family as a supportive means of helping that person change. Individual change is expected to affect the entire family system. The individual is often asked to behave or respond in a different manner. This technique attempts to disrupt a circular system or behavior pattern.
PRESCRIBING INDECISION
The stress level of couples and families often is exacerbated by a faulty decision-making process. Decisions not made in these cases become problematic in themselves. When straightforward interventions fail, paradoxical interventions often can produce change or relieve symptoms of stress. Such is the case with prescribing indecision. The indecisive behavior is reframed as an example of caring or taking appropriate time on important matters affecting the family. A directive is given to not rush into anything or make hasty decisions. The couple is to follow this directive to the letter.
PUTTING THE CLIENT IN CONTROL OF THE SYMPTOM
This technique, widely used by strategic family therapists, attempts to place control in the hands of the individual or system. The therapist may recommend, for example, the continuation of a symptom such as anxiety or worry. Specific directives are given as to when, where, and with whom, and for what amount of time one should do these things. As the client follows this paradoxical directive, a sense of control over the symptom often develops, resulting in subsequent change.
CONCLUSION
The techniques suggested here are examples from those that MFTs utilize to bring about helpful changes in family functioning. MFTs customize them according to presenting problems. With the focus on healthy family functioning, MFTs cannot allow themselves to be limited to a prescribed operational procedure, a rigid set of techniques or set of hypotheses. Therefore, creative judgment and personalization of application are encouraged.
REFERENCES
Coppersmith, E. (1980). The family floor plan: A tool of training, assessment, and intervention in family therapy. Journal of Marital & Family Therapy, 6, 141-145.
Duhl, F. S., Kantor, D., & Duhl, B. S. (1973). Learning Space and action in family therapy: A primer of sculpting. In D. Bloch (Ed.), Techniques of family psychotherapy: A primer. New York: Grune & Stratton.
McColdrick, M., & Gerson, R. (1985). Genograms in family assessment. New York: Norton.
Minuchin, S., & Fishman, H. (1981). Techniques of family therapy. Cambridge, MA: HarvardUniversity Press.
Perls, F. S., Hefferline, R. F., & Goodman, P. (1951). Gestalt therapy. New York: Julian Press.
Sherman, R., & Fredman, N. (1986). Handbook of structural techniques in marriage and family therapy. New York: Brunner/Mazel.
Stuart, R. (1989). Helping couples change. New York: Guildford Press.
Some important writers in the field of Marriage and Family Therapy are:
Nathan Ackerman (psychoanalytic) Tom Andersen (Reflecting practices and dialogues about dialogues) Harlene Anderson (Postmodern Collaborative Therapy and Collaborative Language Systems) Gregory Bateson (1904 – 1980) (cybernetics, systems theory) Insoo Kim Berg (solution focused therapy) Iván Böszörményi-Nagy (Contextual therapy, intergenerational, relational ethics) Murray Bowen (Systems theory, intergenerational) John Bradshaw (author) (systems theory) Milton H. Erickson (hypnotherapy, strategic therapy, brief therapy) Richard Fisch (brief therapy, strategic therapy) James Framo (object relations theory, intergenerational) Harry Goolishian (Postmodern Collaborative Therapy and Collaborataive Language Systems) John Gottman (marriage) Jay Haley (strategic therapy, communications) Lynn Hoffman (strategic, post-systems, collaborative) Don D. Jackson (systems theory) Susan Johnson (Emotionally focused therapy, attachment theory) Walter Kempler (Gestalt psychology) Salvador Minuchin (structural) Braulio Montalvo (structural)[citation needed] Virginia Satir (communications, experiential, conjoint and co-therapy) Mara Selvini Palazzoli (Milan systems) Robin Skynner (Group Analysis) Paul Watzlawick (Brief therapy, systems theory) John Weakland (Brief therapy, strategic therapy, systems theory) Carl Whitaker (Family systems, experiential, co-therapy) Michael White (narrative therapy) Lyman Wynne (Schizophrenia, pseudomutuality) Maria Martiroysan
