FAMILY THERAPY

Dr. Fr. Jacob Mulavarikkal, SVD

“The family is a microcosm of the world. By knowing how to heal the family, I
know how to heal the world” (Satir, 1988).
Difinition – Family.
Complex structure consisting of an interdependent group of individuals who
have a shared sense of history; share emotional ties to one another; and devise
strategies for meeting the needs of individual family members and the group as a
whole.
• Viewed as a system.
System Properties
• A system is any group of interacting, interrelated, or interdependent parts
that form a complex and unified whole that has a specific purpose.
• Systems have purpose
• All parts must be present for a system to carry out its purpose optimally
• The order in which the parts are arranged affects the performance of a
system.
• System attempt to maintain stability.
• Homeostasis.
• Self-correction.
• Feedback
• Assessing what the needs of a particular situation or relationship
are and adjusting to deviations from attaining these.
• Negative feedback loop/Balancing process.
• Positive feedback loop/ Reinforcing process
• One of two option:
Ø Return to the former homeostasis
Ø Create a new homeostasis
Communication
One cannot not communicate.
The report
• The content, the literal meaning of the statement.
The command
• The metacommunication, or the communication about how to interpret the
communication.
• No such thing as a simple message.
• Double bind.
Individual Therapy:
• A strict focus on individual.
• How effective?
• Questions Concerning Family’s role in creating and maintaining
psychological disturbance.
Family Therapy
• Focus on relationship systems and the contexts in which people live,
problems emerge, and solutions may be found.
• Focus -Transactions between members that needed modification if
individual well-being was to be achieved.
• Never easy to pinpoint the start
• Most authorities - Decade following World War II
 1. STRUCTURAL FAMILY THERAPY

• Join the family and accommodate to its members’ style (build alliance)
• Map the family structure (evaluate and assess)
• Intervene to transform the structure to diminish symptoms.

JOINING
• Clear sense of connection & distance
• Matching
• Pace before leading.
• Be an effective communicator: No failures, only feedback.
CONCEPTUALIZATION AND ASSESSMENT
1) Role of the symptom.
2) Subsystems
3) Boundaries
4) Cross-generational coalitions
5) Hierarchy
6) Complementarity
7) Family development
8) Strengths.
1. ROLE OF THE SYMPTOM
• Symptom – a reaction of an ‘organism under stress.
• “..anything that knocks us out of homeostatic balance.”
2. SUBSYSTEM:
• Every family system comprises a number of subsystems.
• Arise as a result of differences.
• Four important subsystems:
o Individual, spousal, parental and sibling.
2.1. COUPLE SUBSYSTEM
• Whether there is clear distinction between the parental and couple
subsystems?
 2.2. PARENTAL SUBSYSTEM:
• First determine who is in it.
• Find out whether they undermining each.
• Determine whether each is able to balance the business and personal
sides of parenting.
• Find out whether kids follow instruction from each parent.
2.3. SIBLING SUBSYSTEM:
• Assess the relations between siblings for tension, conflict, jealousy,
and or hierarchy issues.
• Whether there is a clear distinction between the parental and child
subsystems?
3. CROSS-GENERATIONAL COALITIONS
ALLIANCE
• People who are emotionally close and mutually supportive.
COALITION
• Involve people who are drawn together by an opposition to other family
members.
CROSS-GENERATIONAL COALITION
• When one or both parents trying to enlist the support of the child
against the other parent.
• When one of the parents responds to the child's needs with excessive
concern and devotion (enmeshment) while the other parent withdraws
and becomes less responsive.
• Often covert, but evident by secret between the parent and child or
comments that compliment the child and criticise spouse
• The coalitions can also involve others such as grandparents.
4. BOUNDARY ASSESSMENT
• Desscribe the amount or quality of interactions between subsystems.
• Thresholds that should not be crossed, as well as the conditions under
which they’re more permeable.
• How adaptively family subsystems interact with each other?
 • Diffuse, clear or rigid.
Diffuse boundary:
• No adequate differentiation
• A strong sense of mutuality and connection at the expense of
individual autonomy
• Subsystems separated by a diffuse boundary are said to be
enmeshed.
Rigid boundaries:
• Too much of Differentiation!
• Subsystems separated by a rigid boundary are said to be disengaged.
Clear boundaries:
• Close emotional contact with others while simultaneously allowing
each person to maintain a sense of identity and differentiation.

• Does the couple have clear boundaries that are distinct from their
parenting?
• Does the couple spend time alone not talking about the children?
• Do they report an active sex and romantic life?
• Does each have a set of personal friends?
• What get priority in their schedules? Children? Work? Personal activities?
Couple time?
5. HIERARCHY:
• They define the family pathways for making decisions and controlling the
behavior of its members.
• There are three basic forms of parental hierarchy;
o a) Effective: Parents can set boundaries and limits while still
maintaining emotional connection with their children.
o b) Insufficient: Parents are not able to effectively manage the child’s
behavior and often adapt a permissive parenting style.
o c) Excessive: The rules are developmentally too strict and
unrealistic and consequences are too severe to be effective.
 • Ask: Is the parent-child hierarchy developmentally and culturally
appropriate?
6. COMPLIMENTARITY:
• Check for rigid complementary patterns between family members.
• Good/bad, understanding/strict parent, logical/emotional partner and so
forth.
• The more exaggerated and rigid these roles become, the less adaptable
the individuals and family become.
7. FAMILY DEVELOPMENT
• Four major stages in family development
o Couple formation
o Families with young children
o Families with school-age or adolescent children
o Families with grown up children.
• Families often get stuck transitioning from one stage to another if they fail
to renegotiate boundaries and hierarchy as the family develops.
8. CLIENT AND RELATIONAL STRENGTHS
Abilities:
• Are they able to maintan a job, a hobby, or a relationship?
• Do they have any special talents?
• How the client is functioning in daily life?
Personal Qualities:
• What brings the client to see the therapist is ususally the flip side of a
strength.
o Anxiety: Pay attention to details, desire to perform well, careful and
throughtful about actions, able to plan for future and anticipate
obstacles
o Arguing: Stands up for self and beliefs, fights injustice, wants the
relationship to work, hope for better things
o Anger: Is in touch with feelings and thoguhts, stands up against
injustice, believes in fairness
 • Social strengths or resources:
• Physical support: People who may help with running errands, picking up
children or doing tasks around the house
• Emotional support: Lisening or helping resolve relational problems.
• Community support: Friendship and acceptance provided by any
community.
• Spiritual resources: Find out how a person conceptualizes his relationship
to God.
GOAL SETTING
• Clear boundaries between all subsystems.
• Clear distinction between the couple subsystem and the parental
subsystem.
• Effective parental hierarchy
• Severing of cross-generational coalitions.
• A family structure that promotes the development and growth of
individuals and family.

INTERVENTIONS
1. MAKING COMPLIMENTS & SHAPING COMPETENCE
• Compliments: To encourage behavior that support families in moving
toward their goals,
• Shaping competence involves noticing small successes along the way to
reaching goals.
• Shaping competence also involves refusing to function for the family in
session.
2. COMPLEMENTARITY
• One of the therapeutic goals in family therapy is to help family members
experience their belonging to an entity that is larger than the individual
self.
• This concept is foreign to common experience.
• People generally experience themselves as acting and reacting.
• They Say:
• "My spouse nags me.”
• "My wife is over dependent."
• "My child is disobedient.”
1. Challenges the problem-the family's certainty that there one identified
patient.
2. Challenges the linear notion that one family member is controlling the
system, rather than each member serving as a context of the other.
3. Challenges the family's punctuation of events, introducing a new frame
which teaches family members to see their behavior as part of a larger
whole.
1. CHALLENGE TO THE PROBLEM
• The therapist's first challenge to the certainty of an identified patient
apart from context, may be simple and direct.
In the case of a person with depression:
• Mr. Smith: I am the problem
• Minuchin: Don't be so sure.
2. CHALLENGE TO LINEAR CONTROL
• The therapist challenges the notion that one member can control
the family system. Each person is rather the context of the other.
• Mr. Smith: How come?
• Minuchin: "If your problems were caused by somebody
outside of you, by somebody in the family, who do you think
would cause you to feel so depressed?"
3. CHALLENGE TO PUNCTUATION OF EVENTS
• The therapist challenges the family's epistemology by introducing a
new framing individual behavior as part of a larger whole.
3. ENACTMENTS:
• Enactments are techniques in which the therapist prompts the family to
reenact a conflict or other interaction.
• Enactments are used to both assess and alter the problematic
interactional sequences.
• Altering/ restructuring may take the form:
• Creating a clearer boundary in enmeshed relationship (stopping
people from interrupting and speaking for one another).
• Altering/ restructuring may take the form:
• Increasing engagement by encouraging the expression of empathy
or direct eye contact,
• Improving parental effectiveness by helping the parent successfully
manage a child’s in-session behavior.
Three Phases.
• Observation of spontaneous interactions,
• The invitation: eliciting transactions.
• Redirecting alternative transactions:
Advantages of enactment:
• Live practice with new interactions.
• Reduce illusion that the problem belongs to a single person
• Increases family’s sense of competence.
4. BOUNDARY MAKING
• To help families soften rigid boundaries or strengthen diffuse boundaries.
• Therapist use this techinique to direct who particiaptes and how.
• Can be aimed at the psychological distance between family members
and at the duration of interaction within a significant subsystems.
1. PSYCHOLOGICAL DISTANCE
Soft indicators:
• Often the way family members sit in a session indicates family
members' affiliations.
 • When a family member is talking, the therapist notices who
interrupts or completes information, who supplies confirmation, and
who gives help.
• Use either:
Ø Cognitive constructs or
Ø Concrete maneuvers to create new boundaries.
Cognitive constructs
• "You take his voice."
• "If she answers for you, you don't have to talk."
• "Your father's voice is talking inside of you."
Concrete maneuvers:
• Asking family memebrs to change seats.
• Asing family members to move seats further or closer together or
turn toward one another.
• Having separate sessions with individuals or subsystems to
strengthen subsystem boundaries.
• Asking one or ore memebrs to remain silent during an interaction.
• Blocking interruptions or encouraging pauses for less dominant
persons to speak.
2. DURATION OF INTERACTION
• In these situations, the content of the transaction is less important
than the fact that the transaction occurs.
5. UNBALANCING
• Used for extreme difficulites in hierarchy or when the identified patient is
being scapegoated.
• Used to realign boundaries between subsystems.
• Therapist use the expert position:
• To temporarily join sides with individual who is being scapegoated
• To join with subsystems that need to develop stronger boundaries
before arguing their cause
• To help to explain one of the memebrs perspective to others .
• Three categories,
• Affiliate with family members
• Ignore family members
• Enter into a coalition with some family members against them.
• AFFILIATION WITH FAMILY MEMBERS
• The therapist uses her affiliation with one family member to change
his hierarchical position in the family system.
• The focus on one family member changes the position of all family
members.
• This technique is used mostly to support a peripheral family
member or one in a down position.
• Feeling the therapist's affiliation, that person begins to challenge his
prescribed position in the system.
• IGNORING OF FAMILY MEMBERS
• The family members who are passed over feel challenged in their most
basic right, the right to be recognized.
• They will rebel against such a basic disrespect by some form of
demand or attack.
• Their rebellion against the therapist can take the form of a direct
challenge, but more often it involves a request for other family
members to draw closer.
• This last transaction, which frequently entails a request for a coalition
against the therapist, makes a realignment of family hierarchies
possible.
• COALITION AGAINST FAMILY MEMBERS
• In this unbalancing technique, the therapist participates as a
member of a coalition against one or more family members.
• This kind of direct participation by the therapist requires, on her
part, the ability to confront and to utilize her position of power as the
expert in the system to challenge and disqualify the expertise of a
family member.
 • The success of this strategy requires that family members accept
the value of the transformation for the benefit of the total family.
6.INTENSITY
To create structural shifts in hierarchy and boundaries, especially when
family is having trouble hearing the therapist with other interventions.
• These techniques may include:
• Changing the distance between people involved in a transaction
• Resisting the pull of a family transactional pattern.
7. CHALLENGING A WORLDVIEW
• The therapist offers, something that modifies the boundaries of the known.
EXPERT ADVICE
• With this technique the therapist presents a different explanation of the
family reality, based on his own experience, knowledge, or wisdom:
• "I have seen other cases that ..."
• "If you explore this area, you will find that ...”