Catholic University of America Structural Family Systems Perspective Discussion I need some help with a discussion board question that is due tonight. Atta

Catholic University of America Structural Family Systems Perspective Discussion I need some help with a discussion board question that is due tonight. Attached are the two questions that should be answered. Discussion Board questions
•
Review the “Reframing” PDF provided under Resources. Pick two of the descriptive characteristics
listed on the handout. For each characteristic, think about how you might reframe this for a given family system.
Develop a narrative that you might deliver to a family regarding this characteristic.
Your initial post is due by Wednesday at 11:55pm. Your response to a peer’s post is due by
Saturday at 11:55pm.
•
Discussion Board – Structural Family Systems Perspective
Review the “Unbalancing” PDF provided under Resources. After reviewing the dialogue, critique this segment of a
session from a structural family systems perspective.
•
•
What do you think is the clinical rationale for this approach?
Do you have any concerns regarding this intervention with this family?
Unbalancing Technique
Unbalancing is a term that could be used to encompass most of the therapist’s activity
since the basic strategy that permeates structural family therapy is to create
disequilibrium. In a more restricted sense, however, unbalancing is the technique where
the weight of the therapist’s authority is used to break a stalemate by supporting one of
the terms in a conflict. Toward the end of the consultation with the family of an
“uncontrollable” girl, Minuchin and the couple discuss the wife’s idea that her husband is
too harsh on the girls:
Minuchin. Why does she think that you are such a tough person? Because I think
she feels that you are very tough, and she needs to be flexible because you are
so rigid. I don’t see you at all as rigid, I see you actually quite flexible. How is that
your wife feels that you are rigid, and not understanding?
Husband:
I don’t .know, a lot of times I lose my temper I guess, right?
That’s probably why.
Wife: Yeah.
Minuchin: So what? So does she. I have seen you playing with your daughter
here and I think you are soft and flexible, and that you were playing in a rather
nice and accepting way. You were not authoritarian, you had initiative, your play
engaged her. . . . That is what I saw. So why is that she sees you only as rigid
and authoritarian, and she needs to defend the little girls from your (punches
father’s knee)? I don’t see you that way at all.
Husband: I don’t know, like I say, the only thing I can think of, really, is because I
lose my temper with them.
Wife: Yes, he does have a short fuse.
Minuchin: So what? So do you.
Wife: No, I don’t.
Minuchin: Oh you don’t. Okay, but that doesn’t mean that you are authoritarian,
and that doesn’t mean that you are not understanding. Your play with your
daughter here was full with warmth and you entered very nicely, and as a matter
of fact she enjoyed the way in which you entered to play. So, some way or other
your wife has a strange image of you and your ability to understand and be
flexible. Can you talk with her, how is that she sees that she needs to be
supportive and defending of your daughter? I think she is protecting the girls from
your short fuse, or something like that. Talk with her about that, because I think
she is wrong.
Wife: That’s basically what it is, I’m afraid of you really losing your temper on
them, because I know how bad it is, and they are little, and if you really hit them
with a temper you could really hurt them; and I don’t want that, so that’s why I go
the other way, to show them that everybody in the house doesn’t have that short
fuse.
Husband. Yes, but I think when you do that, that just makes it a little worse
because that makes her think that she has somebody backing her, you know
what I mean?
Minuchin (shakes husband’s hand): This is very clever, and this is absolutely
correct, and I think that you should say it again because your wife does not
understand that point.
In this sequence the consultant unbalances the couple through his support of the
husband. His focus organizes him to disregard the wife’s reasons, which may seem
unfair at first sight. But it is in the nature of unbalancing to be unfair. The therapist
unbalances when he needs to punctuate reality in terms of right and wrong, victim and
villain, actor and reactor, in spite of his knowing that all the comings and goings in the
family are regulated by homeostasis, and that each person obliges with his and her own
contribution; because the therapist also knows that an equitable distribution of guilt’s and
errors would only confirm the existing equilibrium and neutralize change potentialities.
While unbalancing is admittedly and necessarily unfair, it is not arbitrary. Diagnostic
considerations dictate the direction of the unbalancing. In the case of our example, the
consultant chooses to support the husband rather than the wife because in so doing he
is challenging a myth that both spouses share: initially the husband agrees to his wife’s
depiction of him, and it is only through the intensity of the consultant’s message that he
begins to challenge it. At different points in the same session, the consultant supports
the wife as a competent mother and questions the idea of her unremitting inefficiency—
again, a myth defended not only by her husband but by herself as well. In the last
analysis unbalancing—like the entire structural approach—is a challenge to the system
rather than an attack on any member.
REFRAMES FOR STRUCTURAL FAMILY THERAPY
Definition of Reframing- The use of language to give new meaning to a situation
which invites the possibility of change and looking at interactions and dynamics
with a multidimensional lens. For example, relabeling a youth’s depression as
stubbornness or laziness suggests personal responsibility for that behavior and
may change the family’s response to that behavior.
Positive Connotation- This expands on reframing and rather than relabel a
behavior, the therapist positively describes the entire family interaction. This joins
the symptomatic behavior to the context (family) and enables the family to view
both the symptom and itself in a new way.
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Lazy spouse / partner
Overinvolved parent
Distant parent
Jealousy
Adolescent running away
Nagging
Disrespectful teen
Whiney child
Shyness
Eruptive anger
Parent putting down child
Cursing
Extended grief
Clingy child
A person unable to make decisions
Piercy, Fred P., et. al. Family Therapy Sourcebook, (2nd ed.) Guilford Press: New
York, 1996. Print.
Structural
Family
Therapy:
Intervention
SSS 822: Clinical Social Work with Families
Class 7
Principles of Intervention
• Focus on concrete issues which contain
dynamics underlying core issues
• Locate issues in the present
• Work through family experience in session,
enactments with family or with therapist
• Attend to underlying family structure needing
building or repair
Principles of Intervention
• Build on client strengths, generate momentum
• Aim for palpable outcomes, clients should see and
experience change in and out of session
• Engage actively and purposefully through joining
• Altering family structure will have ripple effects
across the entire system
• Families unlikely to consider change until system is
overly stressed
Process of Therapy
• Joining and accommodating
• Structural diagnosis
• Reframing
• Create structural changes
How to “Take Charge” of a
Session
• Concrete questions
• Open-ended questions – help people see their
own process
• Comment on things the family knows to be true
(comment on the obvious), helps to dissolve the
sense of chaos
• Instead of talking about problems, make it
happen
How to “Take Charge” of a
Session
• Go for people’s competence, can be surprisingly
dislocating
• Comment on complementarity – helps
communicate you see the big picture
• Normalizing
• Take a position in a power struggle
Techniques
• Join the family in a position of leadership
• Map the underlying struture
• Intervene to transform structure
• Obtain each member’s view of the problem
Joining and
Accommodation
• Relationship is central to the change process
• Showing respect for individuals as well as
current family structure
• Mimesis – joining through nonverbal mirroring
• Maintenance – supporting certain pre-existing
family structure
• Use of disciplined empathy
Enactments
• Families often describe themselves as how they
think they should be rather than how they are
• Pick specific issue and direct family to talk about
it
• When enactment breaks down, comment on
what went wrong and encourage family to keep
going
• Help family identify alternatives to what is not
working
Structural Mapping
• Develop structural hypothesis early before
therapist becomes too enmeshed
• Consider both presenting problem as well as
structural dynamics
• Don’t focus on any more than two structural
issues at a time
• SFT therapists believed best sessions were “one
issue” sessions
Highlighting and Modifying
Interactions
• Intensity – knowing how and when to be
provocative
• Use of punctuating comments
• Use of empathy / emotion
• Shaping competence – use of functional alternatives
• Doing for family members vs. encouraging them to
do for themselves
Reframing / Relabeling
• Family often presents a proposition of
incompetence, failure, or defeat which can
involve historical or linear thinking
• Challenge of therapist is to offer a
counterproposition
• Problem of one reframed as problem of many,
individual’s behavior contingent on others
Reframing / Relabeling
• Question peoples’ assumptions and structure of
their lives
• Create possibilities instead of paralysis
• Comes out of complementary relationships –
the side people don’t see
• Often normalizes behavior (not the same as
minimizing)
Examples…
• “You two are peas in a pod”
• “The problem isn’t that you two hate each other, it
is that you are too close”
• “There’s nothing wrong with what you’re doing, the
only thing wrong is that it is not what you want”
• “This boy is not a successful delinquent, he got
caught. How could we help him be more
competent in whatever he does?”
Giving Feedback
• Helping families attach to the experience they
are having
• “I asked you not to speak so that your husband
could talk with your son. That was hard work
for you. Did you notice what happened when
you didn’t speak?”
Giving Feedback
• “When he doesn’t go to school, you must feel
helpless. How can you feel hopeful?”
• “Do you notice the difference it makes when
your daughter isn’t sitting between you two?”
Boundary Making
• Strengthening boundaries in enmeshed systems
• Helping disengaged families avoid detouring
• Family members will often think power to
change rests with another person
• Setting context of family members helping each
other change
• May involve blocking or moving client physical
position in room
Unbalancing
• Changing relationships in subsystems
• Families can be balanced in opposition or frozen
• Siding in turn with various members of the
family
• Challenging unproductive assumptions
• Viewed as a challenge to the system and not an
attack on any individual member
Setting Tasks
• The action of therapy
• Therapist is always involved in this process
• Tasks are performed in and out of session
• Make sure tasks are doable and manageable
Ethical Issues
• Imposition of therapist’s own values and beliefs
• Blurring of boundaries between therapist and
client
• Others?
Helpful Resources
• www.minuchincenter.org
• www.harryjaponte.com
• http://philafamily.com
• http://www.psychotherapy.net/video/minuchin
-family-therapy
• www.goodtherapy.org/famouspsychologists/salvador-minuchin.html
SSS 822: Clinical Social Work with Families
Class #6
? Born in 1921 in Argentina, eldest of 3 children, raised
in a family with more than 200 cousins
? Jailed for 3 months after joining a leftist political
movement opposing the dictator Peron who had
taken control of the Argentinian Universities
? 1948 – moved to Israel and joined the army, treated
soldiers who had survived the holocaust
? 1950 came to US and worked at Bellevue where he
lived with 20 disturbed children in institutional
housing
? 1954 – 1958 trained at the William Alanson White
Institute of Psychoanalysis; Trained as a psychiatrist
under Nathan Ackerman
? Began work as a psychiatrist at Wiltwyck, a residential
school for delinquent adolescents. Began to develop
techniques to work with “underorganized” families
? 1965 became the Director of the Philadelphia Child
Guidance Clinic, worked with Jay Haley
? “What is it that makes the big change?”
? “Family structure is the basis for family therapy.”
? “The biggest harm you can do to a family is to help them
stay the same.”
? “If you sit back, you get swept into turmoil.”
? “Structure is so natural that you don’t see it.”
What do these quotes tell you about Minuchin’s and
Aponte’s view of work with families?
? Grew out of work with a specific population in the 1960’s
? Developed to treat minority families who face many
challenges – “Families of the Slums”
? Later applied to family systems presenting with anorexia
– 1978 publication of “Psychosomatic Families”
? An open system
? Interdependent parts
? Impacted by environment
? Homeostasis and Change
System AB (pattern of passivity / initiative)
A’s passivity is a response to B’s initiative
This passivity / initiative pattern is way system carries out it’s
function (function = provision of nurturing environment for
AB)
Set of rule around these interactions = Family Structure
? Look at family as an integrated whole
? The symptoms of one family member are best
?
?
?
?
understood in the context of the family
Individual symptoms are rooted in the context of family
transactional patterns
All family transactions make a statement about power,
boundaries and alignment
Functional and dysfunctional families are determined by
the adequacy of the fit of the family’s structural
organization with the environmental context.
Persistent patterns of interaction provide family rules
? Go to Mom for help with emotional concerns
? Avoid talking to Mary about problems
? Siblings shouldn’t rat each other out
? If Dad worked late, don’t bother him with questions
? Gender role expectations
? Children are not allowed in Mom’s room
? Dad has the final say in family arguments
? Try to work out your conflict with siblings before
asking for parental intervention
? What happens in the family stays in the family
? How does the structure of this family help it to deal with
the surrounding environment?
? How is the family structure articulated by the ways in
which the members communicate?
? Is there a “right” structure or is it different for each
family?
? What are the values of the family which underlie the
structure?
? What is maintaining the symptom or keeping the
symptom alive?
? How can I give this family a new explanation for what is
happening?
? Are the current challenges to family structure coming
from the environment? Or from internal family
developmental processes?
? 3 Primary Subsystems
1) Spousal or Conjugal
2) Parental
3) Sibling (socialization)
* What about parent-child subsystems? Why might
they not be considered as a “primary” subsystem?
? A Newly Partnered Couple
? Addition of the First Child to the Family System
? Launching of Youngest Child from Family System
? What are the developmental tasks associated with
each event?
? How do these specific tasks influence family structure?
? Clear
? Diffuse
? Rigid
Boundaries in a system act to manage proximity and
hierarchy
What do each of these look like in practice?
? Diffuse Boundaries are characterized by enmeshment
where relationships are disproportionately intertwined
? Rigid Boundaries are characterized by disengagement
where family members are disconnected and
insensitive to each others’ needs
? Enmeshment and Disengagement exist on a
continuum and are most often both present in a single
family system. Both patterns serve to prevent conflict
in system which is seen as catalyst for change
? Pathology of Alliances
1) Alliances
2) Coalitions (involve process of scapegoating)
3) Cross-Generational Coalitions (often involves
triangulation)
? Pathology of Triads
Parallel to Bowen’s ideas regarding symptomatic
triangles
? Pathology of hierarchy can take different forms
? Goal of therapist is to assess pathology and work
actively to restructure the family system
? Codependency – relational pattern in which one
member of a subsystem both consciously and
unconsciously sabotages the behavior of another
member
? Involves a dyadic relationship
? Creates a balance
? Influence each other
? Circularity
? Need to explore the side not seen
? Be mindful of power dynamics
? “Be a criminal so that I can be a judge”
? “Be a student so that I can be a teacher”
? Consider a couple where one partner is sweet and
passive and the other is domineering and abrasive
? What is the other side (potentially) of each of these
individuals?
? Application to sexual offender population
? In every victimizer there is a victim
? The treatment of offenders often involves helping helping
people speak from a voice they don’t own
? Dysfunctional families tend to increase rigidity of
structures which aren’t working
? Enmeshment and disengagement often exist in the same
system and are often reciprocal
? Structural problems are often a failure to adjust to
changing circumstances
? Therapists map out or diagram the structure of familial
?
?
?
?
?
?
?
relationships:
Rigid ______
Clear ———Diffused . . . . . . .
Coalition
Conflict
Detouring
Overinvolvement
? Alliance
? Conceptualization of the problem
? Precipitating event
? Hypothesis- what is maintaining the problem? What is
keeping the symptom alive? (not how it came to be)
? Homeostatic function – systems most often support the
symptom
? Sequential significance/ maintenance vs causation
? What are the different perceptions of the problem by
system members? What parts of the problematic
individual are not seen?
? Primary goal of SFT is to reorganize the family structure
? To shift members’ relative position to disrupt
?
?
?
?
?
?
malfunctioning patterns
To strengthen parental hierarchy
Action precedes understanding
To create clear, flexible boundaries
To mobilize more adaptive patterns
Change covert rules that governs transactions
To establish the spousal subsystem as a distinct entity from
the parental subsystem
? How will therapist support (or not support) certain
?
?
?
?
structures?
Using the relationship as intervention
Will therapist be “like” the family, or will they be different
– forcing them to change?
Identify where family is hurting and where it is manifesting
in family
Therapist limits participation to the minimum that is
necessary to set family healing resources in motion
? Enactment = real experience (can be either therapist
induced or spontaneous)
? Intervention = changing person’s experience of
themselves
? Engaging with family and moving together, staying
connected to family momentum
? What is the role of emotion in the structural model /
how does it impact the joining process
? Observer
? Describer
? Director
? Expert
? Educator
? Interpreter
? Reframer
? Therapist represents a different kind of family and a
?
?
?
?
?
different series of responses to life
Importance of balancing challenging and accommodation
Orient toward process and away from cont…
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